Medical Plan Contributions
Tobacco-Free Pledge Rates
| HSA Basic ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
|---|---|---|---|
| Employee Only | $32.25 | $29.77 | $14.88 |
| Employee + Child(ren) | $50.53 | $46.64 | $23.32 |
| Employee + Spouse | $62.89 | $58.05 | $29.03 |
| Family | $96.75 | $89.31 | $44.65 |
| HSA Basic (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $48.38 | $44.65 | $22.33 |
| Employee + Child(ren) | $75.25 | $69.46 | $34.73 |
| Employee + Spouse | $94.60 | $87.32 | $43.66 |
| Family | $145.13 | $133.96 | $66.98 |
| HSA Plus ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $65.58 | $60.53 | $30.27 |
| Employee + Child(ren) | $103.20 | $95.26 | $47.63 |
| Employee + Spouse | $129.54 | $119.58 | $59.79 |
| Family | $174.69 | $161.25 | $80.63 |
| HSA Plus (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $98.37 | $90.80 | $45.40 |
| Employee + Child(ren) | $154.27 | $142.40 | $71.20 |
| Employee + Spouse | $191.89 | $177.13 | $88.56 |
| Family | $273.59 | $252.54 | $126.27 |
| PPO ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $166.09 | $153.31 | $76.66 |
| Employee + Child(ren) | $261.23 | $241.13 | $120.57 |
| Employee + Spouse | $317.13 | $292.73 | $146.37 |
| Family | $398.29 | $367.65 | $183.83 |
| PPO (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $248.87 | $229.72 | $114.86 |
| Employee + Child(ren) | $392.38 | $362.19 | $181.10 |
| Employee + Spouse | $475.15 | $438.60 | $219.30 |
| Family | $597.70 | $551.72 | $275.86 |
Without Tobacco-Free Pledge Rates
| HSA Basic ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
|---|---|---|---|
| Employee Only | $41.93 | $38.70 | $19.35 |
| Employee + Child(ren) | $65.58 | $60.53 | $30.27 |
| Employee + Spouse | $81.70 | $75.42 | $37.71 |
| Family | $125.78 | $116.10 | $58.05 |
| HSA Basic (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $62.89 | $58.05 | $29.03 |
| Employee + Child(ren) | $98.37 | $90.80 | $45.40 |
| Employee + Spouse | $122.55 | $113.12 | $56.56 |
| Family | $188.67 | $174.15 | $87.08 |
| HSA Plus ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $85.47 | $78.89 | $39.45 |
| Employee + Child(ren) | $134.38 | $124.04 | $62.02 |
| Employee + Spouse | $156.95 | $144.88 | $72.44 |
| Family | $215.00 | $198.46 | $99.23 |
| HSA Plus (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $127.93 | $118.08 | $59.04 |
| Employee + Child(ren) | $200.49 | $185.07 | $92.53 |
| Employee + Spouse | $249.40 | $230.22 | $115.11 |
| Family | $355.83 | $328.45 | $164.23 |
| PPO ( $50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $216.08 | $199.45 | $99.73 |
| Employee + Child(ren) | $340.24 | $314.07 | $157.03 |
| Employee + Spouse | $412.27 | $380.55 | $190.28 |
| Family | $517.62 | $477.80 | $238.90 |
| PPO (>$50k) | Semimonthly Cost | Biweekly Cost | Weekly Cost |
| Employee Only | $323.04 | $298.19 | $149.10 |
| Employee + Child(ren) | $509.55 | $470.35 | $235.18 |
| Employee + Spouse | $618.13 | $570.58 | $285.29 |
| Family | $776.69 | $719.94 | $358.47 |
