Page 18 - Genesis Care 2022 Benefit Guide

Medical & Spending Voluntary Additional
Contents Prescription Dental Vision Accounts Life & AD&D Disability Benefits 401(k) Information Contacts

2022 RATES

The following illustrates the 2022 bi-weekly premiums for each benefit option. Supplemental Life Insurance
Non-Wellness Medical Coverage Rates Rates (per $1,000 of coverage)

VALUE HDHP CORE HDHP ENHANCED PPO TEAM SPOUSE/
AGE BANDED DOMESTIC
NON-WELLNESS NON-WELLNESS NON-WELLNESS MEMBER PARTNER
Team Member Only $37.40 $48.00 $219.60 0-29 $0.035 $0.030
Team Member + Spouse / 30-34 $0.046 $0.041
Domestic Partner $107.10 $142.00 $500.40
35–39 $0.069 $0.064
Team Member + Child(ren) $88.40 $115.00 $424.80 40-44 $0.092 $0.087
Family $158.10 $205.00 $702.00 45–49 $0.127 $0.122
50–54 $0.207 $0.202
Dental Coverage Rates 55–59 $0.368 $0.363

60-64 $0.506 $0.501
LOW PLAN HIGH PLAN 65–69 $0.920 $0.915
Team Member Only $9.34 $19.25 70+ $1.495 $1.490
Team Member + Spouse / $18.31 $38.13 CHILD(REN) $0.120
Domestic Partner
Team Member + Child(ren) $20.43 $41.52 Supplemental AD&D Insurance
Family $31.45 $64.53 Rates (per $1,000 of coverage)

Vision Coverage Rates TEAM MEMBER, SPOUSE/DOMESTIC
PARTNER, CHILD(REN)
VISION $0.017
Team Member Only $3.32

Team Member + Spouse / $6.42 Buy-Up Long Term Disability
Domestic Partner (Per $100 Covered Payroll)
Team Member + Child(ren) $5.43
Family $8.53 PHYSICIAN ONLY RATE
$1.29

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