Page 20 - SC Fuels Benefit Guide 2018 TEXAS
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EMPLOYEE CONTRIBUTIONS
Employee Pays (Per Paycheck)
MEDICAL
CIGNA HMO
Employee Only $75.00
Employee + Spouse* $220.00
Employee + Child(ren) $190.00
Employee + Family* $300.00
CIGNA Traditional PPO
Employee Only $65.00
Employee + Spouse* $175.00
Employee + Child(ren) $140.00
Employee + Family* $260.00
CIGNA HSA PPO SC FUELS HSA CONTRIBUTION
Employee Only $48.00 $25.00
Employee + Spouse* $160.00 $41.67
Employee + Child(ren) $120.00 $41.67
Employee + Family* $220.00 $41.67
DENTAL
Guardian PPO
Employee Only $9.00
Employee + 1 $29.00
Employee + Family $54.25
VISION
Ameritas EyeMed Access Network
Employee Only $4.02
Employee + 1 $7.66
Employee + Family $11.34
Ameritas VSP Access Network
Employee Only $5.78
Employee + 1 $10.96
Employee + Family $16.10
*Medical Coverage Only: Spouses and domestic partners who have other medical coverage available to them
through their employer are not eligible to enroll in our plan.
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