Page 24 - Dragados 2022 Benefits Guide

BENEFIT PLAN
MONTHLY
EPO Medical Plan
VOLUNTARY LIFE MONTHLY RATES
Employee and Spouse Voluntary Life Age Bands
Monthly Rate per $1,000
Monthly Rate per $1,000 (EE/Spouse)
Age 20-24
$0.060
$0.050
Age 30-34
$0.080
$0.080
HSA Medical Plan
OAP Medical Plan
PPO Dental Plan
INO Dental Plan
VISION Plan
Age 40-44
$0.110
$0.100
Age 50-54
$0.270
$0.230
Age 60-64
$0.660
$0.660
Age 70-74
$2.190
$2.060
Age 80-84
$10.045
$2.060
Age 90-94
$10.045
$2.060
$10.045
$2.060
$10.045
$2.060
Child(ren) Voluntary Life Rate
24
Dragados 2022 Benefits Guide
2022 Monthly Employee Contributions
Employee
Employee + Spouse
Employee + Child(ren)
Family
Employee
Employee + Spouse
Employee + Child(ren)
Family
Employee
Employee + Spouse
Employee +Child(ren)
Family
Employee
Employee + Spouse
Employee + Child(ren)
Family
Employee
Employee + Spouse
Employee + Child(ren)
Family
Employee
Employee + Spouse
Employee + Children
Family
$14.17
$165.77 Less than Age
$149.87
$290.38 Age 25-29
$97.94 Age 35-39
$268.74
$252.55 Age 45-49
20
$0.060 $0.050 $0.060 $0.060 $0.090 $0.090 $0.165 $0.150 $0.430 $0.430 $1.270 $1.270 $6.087 $2.060
$0.210
$394.61
$226.82
Age 55-59
$547.35 Age 65-69
$495.03
$835.92 Age 75-79
$2.58 Age 85-89
$10.23
$10.10 Age 95-99
$22.87
$0.91
$3.29
$3.96
$8.73
$6.07
$9.72
$9.92
$16.00
Child(ren) rate
Medical, dental and vision employee contributions are taken through pre-tax payroll deductions.
Employee contributions for Domestic Partner Coverage will have tax implications. Contact HR/Payroll for more information.
Medical Plans Opt-Out Benefit:
Employees who waive medical coverage and provide proof that they have qualifying coverage elsewhere are eligible to receive an opt-out benefit payment of $250 per month (contact your HR/Payroll for more information).