Your payroll contributions for medical, dental, vision and voluntary accident, critical illness, hospital indemnity benefits and voluntary legal services are shown below.
If you work in Hawaii, view the employee contributions for the HSMA medical plans.
Medical
| SEMI-MONTHLY COST | BCBSIL $500 DEDUCTIBLE PPO | BCBSIL $1,500 DEDUCTIBLE PPO | BCBSIL $3,500 DEDUCTIBLE HDHP WITH HSA |
|---|---|---|---|
| Employee | $133.33 | $88.78 | $23.54 |
| Employee/Spouse | $485.78 | $399.80 | $199.96 |
| Employee/Children | $468.16 | $385.30 | $192.71 |
| Family | $722.38 | $594.53 | $297.35 |
Dental
| SEMI-MONTHLY COST | METLIFE PPO 1000 | METLIFE PPO 2000 |
|---|---|---|
| Employee | $0.00 | $5.02 |
| Employee/Spouse | $20.80 | $30.63 |
| Employee/Children | $29.49 | $37.62 |
| Family | $55.76 | $69.28 |
Vision
| SEMI-MONTHLY COST | METLIFE VSP CHOICE |
|---|---|
| Employee | $0.00 |
| Employee/Spouse | $3.39 |
| Employee/Children | $2.35 |
| Family | $6.07 |
Accident Plan
| SEMI-MONTHLY COST | METLIFE ACCIDENT PLAN | |
|---|---|---|
| Employee | $3.32 | |
| Employee/Spouse | $6.64 | |
| Employee/Children | $8.11 | |
| Family | $9.53 | |
Critical Illness
Critical Illness rates are based on the employee’s own age and, if applicable, their spouse’s own age.
Rates reflect spouse coverage at 50% of the employee’s benefit amount and child coverage at 25% of the employee’s benefit amount.
Rates displayed are for non-tobacco users. If you or a covered spouse are tobacco users, rates will be available at the time of enrollment.
| AGE | METLIFE CRITICAL ILLNESS PLAN (SEMI-MONTHLY COST): OPTION 1 - $10,000* | |
|---|---|---|
| EMPLOYEE | SPOUSE | |
| Non-Tobacco | Non-Tobacco | |
| Under 25 | $2.25 | $1.43 |
| 25-29 | $2.50 | $1.55 |
| 30-34 | $2.95 | $1.73 |
| 35-39 | $3.65 | $2.05 |
| 40-44 | $4.75 | $2.55 |
| 45-49 | $6.20 | $3.30 |
| 50-54 | $7.60 | $4.35 |
| 55-59 | $9.90 | $6.03 |
| 60-64 | $12.60 | $7.98 |
| 65-69 | $16.20 | $10.58 |
| 70-74 | $21.45 | $13.73 |
| 75+ | $31.35 | $18.43 |
| Child(ren) Coverage: $0.88 | ||
| AGE | METLIFE CRITICAL ILLNESS PLAN (SEMI-MONTHLY COST): OPTION 2 - $20,000* | |
|---|---|---|
| EMPLOYEE | SPOUSE | |
| Non-Tobacco | Non-Tobacco | |
| Under 25 | $4.50 | $2.85 |
| 25-29 | $5.00 | $3.10 |
| 30-34 | $5.90 | $3.45 |
| 35-39 | $7.30 | $4.10 |
| 40-44 | $9.50 | $5.10 |
| 45-49 | $12.40 | $6.60 |
| 50-54 | $15.20 | $8.70 |
| 55-59 | $19.80 | $12.05 |
| 60-64 | $25.20 | $15.95 |
| 65-69 | $32.40 | $21.15 |
| 70-74 | $42.90 | $27.45 |
| 75+ | $62.70 | $36.85 |
| Child(ren) Coverage: $1.75 | ||
Hospital Indemnity
| SEMI-MONTHLY COST | METLIFE HOSPITAL INDEMNITY PLAN | |
|---|---|---|
| Option 1 - $500 Admission | Option 2 - $1,000 Admission | |
| Employee | $6.04 | $11.11 |
| Employee/Spouse | $10.17 | $18.72 |
| Employee/Children | $8.77 | $16.13 |
| Family | $12.90 | $23.73 |
Legal Services
| SEMI-MONTHLY COST | METLIFE LEGAL PLAN | |
|---|---|---|
| Employee | $9.00 | |