OPEN ENROLLMENT 2016 CONTRIBUTION RATES
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1 OPEN ENROLLMENT 2016 CONTRIBUTION RATES UHC MEDICAL COVERAGE 2016 FULL-TIME WITH BASE SALARY $35,000 EE $15.00 $ $6.92 $ $20.00 $ EE+SP/DP $84.00 $ $38.77 $ $ $1, EE+ Child(ren) $63.00 $ $29.08 $ $84.00 $1, Family $ $1, $65.54 $ $ $1, EE $36.00 $ $16.62 $ $48.00 $ EE+SP/DP $ $ $ $ $ $1, EE+ Child(ren) $ $ $89.54 $ $ $ Family $ $1, $ $ $ $1, EE $ $ $52.62 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $1, $ $ $ $1, EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 1 CONTRIBUTION RATES
2 2016 FULL-TIME WITH BASE SALARY $35, $60,000 EE $60.00 $ $27.69 $ $80.00 $ EE+SP/DP $ $ $80.31 $ $ $1, EE+ Child(ren) $ $ $70.62 $ $ $ Family $ $1, $ $ $ $1, EE $ $ $48.92 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $1, $ $ $ $1, EE $ $ $73.38 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $ $1, EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 2 CONTRIBUTION RATES
3 2016 FULL-TIME WITH BASE SALARY $60, $120,000 EE $60.00 $ $27.69 $ $80.00 $ EE+SP/DP $ $ $80.31 $ $ $1, EE+ Child(ren) $ $ $70.62 $ $ $ Family $ $1, $ $ $ $1, EE $ $ $48.92 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $1, $ $ $ $1, EE $ $ $73.38 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $ $1, EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 3 CONTRIBUTION RATES
4 2016 FULL-TIME WITH BASE SALARY $120, $180,000 EE $67.00 $ $30.92 $ $89.33 $ EE+SP/DP $ $ $89.54 $ $ $1, EE+ Child(ren) $ $ $78.92 $ $ $ Family $ $1, $ $ $ $1, EE $ $ $54.46 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $ $1, EE $ $ $81.69 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $ $1, EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 4 CONTRIBUTION RATES
5 2016 FULL-TIME WITH BASE SALARY $180, $240,000 EE $70.00 $ $32.31 $ $93.33 $ EE+SP/DP $ $ $93.69 $ $ $1, EE+ Child(ren) $ $ $82.62 $ $ $ Family $ $1, $ $ $ $1, EE $ $ $57.23 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $ $1, EE $ $ $85.38 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $1, $1, EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 5 CONTRIBUTION RATES
6 2016 FULL-TIME WITH BASE SALARY >$240,000 EE $73.00 $ $33.69 $ $97.33 $ EE+SP/DP $ $ $97.38 $ $ $1, EE+ Child(ren) $ $ $85.85 $ $ $ Family $ $1, $ $ $ $1, EE $ $ $59.54 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $ $1, EE $ $ $89.08 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $1, $1, EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 6 CONTRIBUTION RATES
7 2016 PART-TIME PART TIME EE $93.00 $ $42.92 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $ $ EE $ $ $97.85 $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $ $ $ $ $1, $ EE $ $ $ $ $ $ EE+SP/DP $ $ $ $ $ $ EE+ Child(ren) $ $ $ $ $ $ Family $1, $ $ $ $1, $ EE = SP/DP = Spouse/Partner 9-Month s, please note: There are no employee or contributions during June, July, or August. 7 CONTRIBUTION RATES
8 DENTAL COVERAGE FULL-TIME AND PART-TIME COVERAGE CATEGORIES MONTHLY (PAID OVER 12 MONTHS) BIWEEKLY PAID OVER 9 MONTHS DMO Only $21.64 $9.99 $ One $49.45 $22.82 $ Family $59.84 $27.62 $79.79 HIGH PPO Only $52.01 $24.00 $ One Dependent $ $52.05 $ Family $ $62.99 $ LOW PPO Only $31.12 $14.36 $ One Dependent $66.12 $30.52 $ Family $80.04 $36.94 $ Month s, please note: There are no employee or contributions during June, July, or August. 8 CONTRIBUTION RATES
9 UHC VISION COVERAGE FULL-TIME AND PART-TIME MONTHLY (PAID OVER 12 MONTHS) BIWEEKLY PAID OVER 9 MONTHS BASIC Only $4.99 $2.30 $ One $9.24 $4.26 $ Family $14.73 $6.80 $19.64 ENHANCED Only $7.24 $3.34 $ One $13.40 $6.18 $ Family $21.36 $9.86 $ Month s, please note: There are no employee or contributions during June, July, or August. 9 CONTRIBUTION RATES
10 2016 LIFE AND AD&D RATES ADDITIONAL CHILD LIFE MONTHLY RATE PER $1,000 OF COVERAGE Flat Rate* $0.103 ADDITIONAL EMPLOYEE AND SPOUSE LIFE** MONTHLY RATE PER $1,000 OF COVERAGE age 19 and younger $0.05 ages $0.05 ages $0.06 ages $0.08 ages $0.09 ages $0.12 ages $0.22 ages $0.39 ages $0.66 ages $0.90 ages $1.62 ages $2.15 age 75 and older $2.44 ADDITIONAL EMPLOYEE AD&D MONTHLY RATE PER $1,000 OF COVERAGE $0.035 ADDITIONAL SPOUSE AD&D MONTHLY RATE PER $1,000 OF COVERAGE $0.035 ADDITIONAL CHILD AD&D MONTHLY RATE PER $1,000 OF COVERAGE $0.035 * The premium paid for child coverage is based on the cost of coverage for one child, regardless of how many children you have. ** NOTE: For additional life, the rate will increase as the covered participant ages and moves to the next age band. This will occur on January 1st following the covered participant s birthdate. 10 CONTRIBUTION RATES
11 2016 LONG-TERM DISABILITY AND SHORT-TERM DISABILITY RATES* SHORT-TERM VOLUNTARY DISABILITY (EMPLOYEE PAID) RATES ages $ ages $ ages $ ages $ ages $ ages $ ages $ ages $ ages $ ages $ age 70 and over $ * NOTE: For short-term voluntary disability, the rate will increase as the covered participant ages and moves to the next age band. This will occur on January 1st following the covered participant s birthdate. CALCULATE YOUR MONTHLY COST: 1. Determine your weekly benefit if disabled: Annual benefits salary 52 x Take your weekly benefit times your age band rate. (If Weekly Benefit is over $3,000, use $3,000.) SAMPLE CALCULATION FOR 35 YEAR OLD EARNING $40,000 A YEAR: 1. $40,000 x.60 = $ $ x.0183 = $8.45 LONG-TERM DISABILITY RATE Buy-Up Benefit 0.057% TO CALCULATE YOUR MONTHLY COST: 1. Determine your monthly covered payroll: Annual benefits salary Take your monthly covered payroll times (If Monthly Payroll is over $18,000, use $18,000.) SAMPLE CALCULATION FOR SOMEONE EARNING $45,000 A YEAR: 1. $45,000 = $3, $3, x = $2.48 Note: Your rate will increase as you age and move to the next age band. This will occur on January 1st following your birthdate. 11 CONTRIBUTION RATES
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