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2017 ABC Company Bi-weekly Healthcare Rates
Full‐Time Employee Contribution
Coverage
Level
Non‐Working Spouse
& Non‐Tobacco
Tobacco Only
Spousal
Surcharge /
Non‐Tobacco
Spousal
Surcharge &
Tobacco
Part‐time
Employee
Contribution
Cigna OAP Plan (Gold)
EE
EE/Spouse
EE/Child
Family
Cigna HRA Plan (Silver)
EE
EE/Spouse
EE/Child
Family
Cigna Catastrophic Plan (Bronze)
EE
EE/Spouse
EE/Child
Family
Coverage Level
Full‐time
Employee
Contribution
Part‐time
Employee
Contribution
Cigna PPO Dental ‐ High
EE
EE/Spouse
EE/Child
Family
Cigna PPO Dental ‐ Low
EE
EE/Spouse
EE/Child
Family
Cigna Vision
EE
EE/Spouse
EE/Child
Family