Medical Plan Contributions
Tobacco-Free Pledge Rates
| HSA Basic ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
|---|---|---|---|
| Employee Only | $30.00 | $27.69 | $13.85 |
| Employee + Child(ren) | $47.00 | $43.38 | $21.69 |
| Employee + Spouse | $58.50 | $54.00 | $27.00 |
| Family | $90.00 | $83.08 | $41.54 |
| HSA Basic (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $45.00 | $41.54 | $20.77 |
| Employee + Child(ren) | $70.00 | $64.62 | $32.31 |
| Employee + Spouse | $88.00 | $81.23 | $40.62 |
| Family | $135.00 | $124.62 | $62.31 |
| HSA Plus ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $61.00 | $56.31 | $28.15 |
| Employee + Child(ren) | $96.00 | $88.62 | $44.31 |
| Employee + Spouse | $120.50 | $111.23 | $55.62 |
| Family | $162.50 | $150.00 | $75.00 |
| HSA Plus (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $91.50 | $84.46 | $42.23 |
| Employee + Child(ren) | $143.50 | $132.46 | $66.23 |
| Employee + Spouse | $178.50 | $164.77 | $82.38 |
| Family | $254.50 | $234.92 | $117.46 |
| PPO ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $162.50 | $150.00 | $75.00 |
| Employee + Child(ren) | $256.00 | $236.31 | $118.15 |
| Employee + Spouse | $310.50 | $286.62 | $143.31 |
| Family | $390.00 | $360.00 | $180.00 |
| PPO (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $243.50 | $224.77 | $112.38 |
| Employee + Child(ren) | $384.00 | $354.46 | $177.23 |
| Employee + Spouse | $465.50 | $429.69 | $214.85 |
| Family | $585.00 | $540.00 | $270.00 |
Without Tobacco-Free Pledge Rates
| HSA Basic ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
|---|---|---|---|
| Employee Only | $39.00 | $36.00 | $18.00 |
| Employee + Child(ren) | $61.00 | $56.31 | $28.15 |
| Employee + Spouse | $76.00 | $70.15 | $35.08 |
| Family | $117.00 | $108.00 | $54.00 |
| HSA Basic (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $58.50 | $54.00 | $27.00 |
| Employee + Child(ren) | $91.50 | $84.46 | $42.23 |
| Employee + Spouse | $114.00 | $105.23 | $52.62 |
| Family | $175.50 | $162.00 | $81.00 |
| HSA Plus ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $79.50 | $73.38 | $36.69 |
| Employee + Child(ren) | $125.00 | $115.38 | $57.69 |
| Employee + Spouse | $146.00 | $134.77 | $67.38 |
| Family | $200.00 | $184.62 | $92.31 |
| HSA Plus (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $119.00 | $109.85 | $54.92 |
| Employee + Child(ren) | $186.50 | $172.15 | $86.08 |
| Employee + Spouse | $232.00 | $214.15 | $107.08 |
| Family | $331.00 | $305.54 | $152.77 |
| PPO ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $211.50 | $195.23 | $97.62 |
| Employee + Child(ren) | $333.00 | $307.38 | $153.69 |
| Employee + Spouse | $403.50 | $372.46 | $186.23 |
| Family | $507.00 | $468.00 | $234.00 |
| PPO (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $316.50 | $292.15 | $146.08 |
| Employee + Child(ren) | $499.00 | $460.62 | $230.31 |
| Employee + Spouse | $605.00 | $558.46 | $279.23 |
| Family | $760.50 | $702.00 | $351.00 |
