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16
Employee Contributions for 2016-2017
The employee’s contribution is deducted from each paycheck on a pre-tax basis. Listed
below are the deduction amounts on a per pay basis (bi-weekly).
*To elect Employee/Spouse or Family coverage, your spouse must not be eligible for medical benefits through his/her
own employer.
Full Time Bi-Weekly (per pay) rates:
Plan
Employee
Only
Employee
Plus Child(ren)
Employee
Plus Spouse*
Family*
Choice POS HDHP
$ 23.73
$ 82.65
$276.91
$399.91
Select HMO
$ 87.15
$194.61
$393.00
$524.61
Dental DMO
$ 1.92
$ 10.77
$ 12.44
$ 23.33
Dental Low
$ 3.84
$ 17.94
$ 19.57
$ 34.15
Dental High
$ 10.01
$ 30.24
$ 31.95
$ 50.82
Part Time Bi-Weekly (per pay) Rates:
Hours Per
Pay
Plan
Employee
Only
Employee /
Child(ren)
Employee /
Spouse*
Family*
72 Hours
Choice POS HDHP
$ 44.41
$111.60
$292.15
$417.22
Select HMO
$151.29
$260.11
$464.08
$606.42
Dental DMO
$ 3.35
$ 11.84
$ 13.40
$ 24.88
Dental Low
$ 5.73
$20.22
$ 21.70
$ 36.14
Dental High
$ 12.11
$32.89
$ 31.97
$ 50.84
64 Hours
Choice POS HDHP
$ 44.41
$111.60
$292.15
$417.22
Select HMO
$151.29
$260.11
$464.08
$606.42
Dental DMO
$ 3.83
$ 12.92
$ 14.35
$ 25.81
Dental Low
$ 7.08
$ 21.57
$ 22.41
$ 36.84
Dental High
$ 13.44
$ 34.25
$ 31.98
$ 50.85
60 Hours
Choice POS HDHP
$ 44.41
$111.60
$292.15
$417.22
Select HMO
$151.29
$260.11
$464.08
$606.42
Dental DMO
N/A
N/A
N/A
N/A
Dental Low
N/A
N/A
N/A
N/A
Dental High
N/A
N/A
N/A
N/A
56 Hours
Choice POS HDHP
$104.68
$217.33
$342.03
$462.57
Select HMO
$215.67
$378.35
$648.24
$798.94
Dental DMO
$ 4.31
$ 14.00
$ 15.31
$ 26.75
Dental Low
$ 8.43
$ 22.91
$ 23.11
$ 37.55
Dental High
$ 14.79
$ 34.70
$ 31.99
$ 50.86
48 Hours
Choice POS HDHP
$104.68
$217.33
$342.03
$462.57
Select HMO
$215.67
$378.35
$648.24
$798.94
Dental DMO
$ 4.79
$ 15.07
$ 16.27
$ 27.68
Dental Low
$ 9.78
$ 24.26
$ 23.75
$ 37.81
Dental High
$ 15.96
$ 34.98
$ 32.00
$ 50.87
40 Hours
Choice POS HDHP
$104.68
$217.33
$342.03
$462.57
Select HMO
$215.67
$378.35
$648.24
$798.94
Dental DMO
$ 5.27
$ 16.15
$ 17.22
$ 28.62
Dental Low
$ 11.13
$ 25.61
$ 23.80
$ 38.28
Dental High
$ 16.13
$ 35.03
$ 32.01
$ 50.88