2021 Employee Benefits Guide 2021 Employee Benefits Guide | Page 15

MEDICAL AND PHARMACY PLAN - RATES

The table below shows your bi-weekly contribution ( what you pay ) for the two different health plans offered by the City . Completing the requirements of the Wellness for Life program ( page 30 ) the year prior will earn lower premium amounts , as indicated below by the Wellness Rate . Note that payroll deductions may differ slightly due to rounding .
Plan Option Wellness Rate Non-Wellness Rate City Rate
Value Plan ( Previously HDHP Plan )
Bi-Weekly Annual Bi-Weekly Annual Bi-Weekly Annual
Employee-Only
$ 13.68
$ 355.68
$ 33.68
$ 875.68
$ 279.33
$ 7,262.71
Employee + Spouse
$ 57.87
$ 1,504.62
$ 77.87
$ 2,024.62
$ 550.13
$ 14,303.26
Employee + Children
$ 22.80
$ 592.80
$ 42.80
$ 1,112.80
$ 456.41
$ 11,866.71
Employee + Family
$ 81.28
$ 2,113.28
$ 101.28
$ 2,633.28
$ 772.48
$ 19,312.00
Core Plan ( Previously EPO Plan )
Bi-Weekly Annual Bi-Weekly Annual Bi-Weekly Annual
Employee-Only
$ 30.44
$ 791.44
$ 50.44
$ 1,311.44
$ 293.90
$ 7,641.49
Employee + Spouse
$ 128.78
$ 3,348.28
$ 148.78
$ 3,868.28
$ 547.63
$ 14,238.28
Employee + Children
$ 76.13
$ 1,979.38
$ 96.13
$ 2,499.38
$ 457.01
$ 11,882.26
Employee + Family
$ 180.84
$ 4,701.84
$ 200.84
$ 5,221.84
$ 769.01
$ 19,994.18
City of Arlington / EMPLOYEE BENEFITS GUIDE 2021
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