Page 21 - CPSS Benefit Guide Class 3 Employee

Benefit Costs

Your payroll contributions for medical, dental and vision benefits are shown here.

Medical - Rates per month Rates per pay period
$1,500 PPO
Employee Only $96.69 $48.35
Benefit Tax Treatment
Employee + Child(ren) $356.37 $178.19 Medical and Pharmacy Pretax
First Stop Health N/A
Family $486.63 $243.32
Dental Pretax
Vision Pretax
Medical - Rates per month Rates per pay period
$2,300 HSA Health Savings Account Pretax
Basic Life and AD&D
Employee Only $63.49 $31.75 After-tax
Insurance
Employee + Child(ren) $284.95 $142.48 Voluntary Life and AD&D After-tax
Insurance
Family $396.91 $198.46
Short-Term Disability After-tax
Long-Term Disability After-tax
Dental Rates per month Rates per pay period Accident Insurance After-tax
Critical Illness Insurance After-tax
Employee Only $21.62 $10.81
401(k) Retirement Savings Pretax or After-
Employee + Spouse $44.80 $22.40 Plan Tax

Employee + Child(ren) $60.14 $30.07
Family $88.04 $44.02

Vision Rates per month Rates per pay period

Employee Only $6.45 $3.23
Employee + Spouse $12.26 $6.13

Employee + Child(ren) $12.90 $6.45
Family $18.97 $9.49

21