Page 6 - Hospice Benefits Enrollments Guide
P. 6
2017 Employee per Pay
Period Contributions
HDHP Medical Plan
Employee per Pay Period Deductions
Employee + Employee + Employee +
Employee
Spouse Child(ren) Family
$15 $180 $50 $230
HRA Medical Plan
Employee per Pay Period Deductions
Employee + Employee + Employee +
Employee
Spouse Child(ren) Family
$50 $260 $95 $295
PPO Medical Plan
Employee per Pay Period Deductions
Employee + Employee + Employee +
Employee
Spouse Child(ren) Family
$75 $300 $180 $360
Dental Employee per Pay Period Deductions
Employee + Employee + Employee +
Employee
Spouse Child(ren) Family
$6.50 $18.00 $17.50 $19.00
Voluntary Vision Employee per Pay Period Deductions
Employee + Employee + Employee +
Employee
Spouse Child(ren) Family
$3.21 $5.94 $6.26 $9.48
-Spousal Surcharge of $50.00 per pay period will apply if you are enrolling a working spouse that has access to
group health coverage through his/her employer. The surcharge will be deducted on a post-tax basis.
-Tobacco Use Surcharge of $60.00 per pay period will apply if you or anyone in your family has used tobacco
products in the last 90 days. Surcharge will only apply if you and your dependents are covered under a HPCC
group medical plan. You may re-certify in December if you and your covered dependents have ceased using
tobacco products and surcharge may be removed in January 2018.
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