12
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