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2018 Benefits Guide
14
EMPLOYEE COST PER PAY PERIOD
Medical
E9F
$1,000 Ded
E9J
$1,500 Ded
E9B
$5,000 Ded
E9Y (HSA)
$3,000 Ded
Employee
$86.80
$55.80
$40.00
$26.05
Employee & Spouse
$355.85
$290.80
$257.65
$228.35
Employee & Child(ren)
$306.95
$248.05
$218.10
$191.55
Family
$551.55
$461.70
$416.00
$375.45
Dental
P5430
Employee
$13.00
Employee & Spouse
$25.95
Employee & Child(ren)
$26.20
Family
$40.35
Vision
V1008
Employee
$3.30
Employee & Spouse
$6.28
Employee & Child(ren)
$7.33
Family
$10.33
Health Savings Account (HSA)
If participating, what is your monthly contribution?
(Yearly Maximums: Individual $3,450; Family $6,900
and if you are 55 or older, you can make “catch-up” contributions of an additional $1,000 per year.)
Contact Human Resources to obtain the H.S.A. contribution form.