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COST OF COVERAGE
M E D I C A L
B l u e S h i e l d A c c e s s + H M O
S a v e N e t
Y o u r W e e k l y C o s t
Employee Only
$15.48
Employee + Spouse
$71.20
Employee + Child(ren)
$52.62
Employee + Family
$89.77
B l u e S h i e l d A c c e s s + H M O
F u l l N e t wo r k
Y o u r W e e k l y C o s t
Employee Only
$21.92
Employee + Spouse
$93.81
Employee + Child(ren)
$69.34
Employee + Family
$118.28
B l u e S h i e l d P P O
Y o u r W e e k l y C o s t
Employee Only
$56.26
Employee + Spouse
$172.79
Employee + Child(ren)
$127.72
Employee + Family
$217.87
B l u e S h i e l d H D H P
Y o u r W e e k l y C o s t
Employee Only
$25.16
Employee + Spouse
$101.26
Employee + Child(ren)
$74.84
Employee + Family
$127.67
V i s i o n
E y e M e d V i s i o n
Y o u r W e e k l y C o s t
Employee Only
$1.68
Employee + Spouse
$3.20
Employee + Child(ren)
$3.37
Employee + Family
$4.95
D E N T A L
D e n t a l N e t H M O
( C A O n l y )
Y o u r W e e k l y C o s t
Employee Only
$1.71
Employee + Spouse
$5.11
Employee + Child(ren)
$4.91
Employee + Family
$9.20
D e n t a l N e t P P O
Y o u r W e e k l y C o s t
Employee Only
$4.39
Employee + Spouse
$12.85
Employee + Child(ren)
$17.93
Employee + Family
$26.39
C O M P A N Y P A I D B E N E F I T S
Company Plans
Your Wee kly Cos t
Benefi t
Basic Life/AD&D Insurance
$0.00
100% Employer Paid
Long Term Disability
$0.00
100% Employer Paid
Employee Assistance Program
$0.00
100% Employer Paid
V O L U N T A R Y S H O R T T E R M
D I S A B I L I T Y
M o n t h l y R a t e P e r $ 1 0 o f W e e k l y B e n e f i t
All Ages
$0.58
V O L U N T A R Y L I F E / A D & D r a t e s p e r $ 1 , 0 0 0 f o r e m p l o y e e & s p o u s e
Employe e Ag e
Mon thly
Rates
Employe e Ag e
Mon thly Rates
Employe e Ag e
Mon thly Rates
Age 15 – 29
$0.076
Age 50 – 54
$0.510
Age 75 – 79
$6.352
Age 30 – 34
$0.085
Age 55 – 59
$0.814
Age 80 – 84
$12.516
Age 35 – 39
$0.125
Age 60 – 64
$1.361
Age 85 – 89
$20.603
Age 40 – 44
$0.217
Age 65 – 69
$2.208
Age 90 – 94
$32.264
Age 45 – 49
$0.336
Age 70 – 74
$3.588
Age 95 – 99
$32.264
Voluntar y Chi ld Li f e/AD&D per $1 ,0 00
$0.209
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