For Employees Hired Prior to 1/1/2018 and After 9/28/2006
Full Monthly Premium Rates |
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---|---|---|---|---|
Coverage | CDPHP HMO | MVP HMO | Empire Blue Cross EPO | |
Single | $836.65 | $868.52 | $1,168.77 | |
Two Person | $1,678.98 | $1,998.33 | $2,280.94 | |
Family | $2,180.29 | $2,128.15 | $3,388.50 |
*** Employee Bi-Weekly Share of Premium Cost at 20% *** |
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---|---|---|---|---|
Coverage | CDPHP HMO | MVP HMO | Empire Blue Cross EPO | |
Single | $77.41 | $80.17 | $107.89 | |
Two Person | $154.98 | $184.46 | $210.55 | |
Family | $201.26 | $196.44 | $312.78 |
If you have Family Dental Coverage the bi-weekly cost will be $24.86 for 2021. There is no payroll deduction for individual dental coverage.
Employee Annual Share of Premium Cost at 20% |
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---|---|---|---|---|
Coverage | CDPHP HMO | MVP HMO | Empire Blue Cross EPO | |
Single | $2,012.76 | $2,084.45 | $2,805.05 | |
Two Person | $4,029.55 | $4,795.99 | $5,474.26 | |
Family | $5,232.70 | $5,107.56 | $8,132.40 |
Plan Benefit Highlights |
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---|---|---|---|---|
Coverage | CDPHP HMO | MVP HMO | Empire Blue Cross EPO | |
In Network | ||||
Doctor Co-Pay | $25.00 | $25.00 | $25.00 | |
Specialist Co-Pay | Same as above | $40.00 | $25.00 | |
Drug Co-Pay | $10G/$25B/$40NF | $10G/$30B/$50NF | $10G/$25B/$50NF | |
Inpatient Co-Pay | 0 | $500 | $100 | |
Out of Network | ||||
Deductible | NA | NA | NA | |
Coinsurance | NA | NA | NA | |
Inpatient Co-Pay | 0 | $500 | 0 |
*The payroll deduction for family dental coverage will be $24.86 for 2021. There is no payroll deduction for individual dental coverage.*
NOTE-THE EMPLOYEE SHARE LISTED ABOVE IS FOR FULL-TIME EMPLOYEES. IF YOU ARE NOT A FULL-TIME EMPLOYEE, THE HEALTH INSURANCE COVERAGE WILL COST YOU MORE, DEPENDING UPON THE NUMBER OF HOURS WORKED PER WEEK.
Plan information, including summaries of benefits and coverage (SBC) and links to health plan websites, can be found here.
*** ANY PAYROLL DEDUCTIONS THAT ARE REQUIRED FOR ANY COVERAGE YOU ELECT WILL COME OUT OF YOUR PAYCHECK THE PAY-PERIOD BEFORE THE COVERAGE IS EFFECTIVE.
Flexible Spending Account - Plan Information
Additional required notices - Children's Health Insurance Program (CHIP), WOMEN'S HEALTH and CANCER RIGHTS ACT
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