2023 Employee Benefits Guide | Page 10

Medical
Medical Surcharges
Dental

RATES

2023 EMPLOYEE PREMIUMS
January 1 , 2023 - December 31 , 2023

Medical

Employee Premiums Wellness Wellness Non-Wellness Non-Wellness
Value Plan Biweekly Monthly Biweekly Monthly Employee Only $ 14.23 $ 30.83 $ 34.23 $ 74.17 Employee + Children $ 23.72 $ 51.39 $ 43.72 $ 94.73
Employee + Spouse
$ 60.18
$ 130.39
$ 80.18
$ 173.72
Employee + Family
$ 84.53
$ 183.15
$ 104.53
$ 226.48
Core Plan Biweekly Monthly Biweekly Monthly Employee Only $ 31.66 $ 68.60 $ 51.66 $ 111.93 Employee + Children $ 79.18 $ 171.56 $ 99.18 $ 214.89 Employee + Spouse $ 133.93 $ 290.18 $ 153.93 $ 333.52 Employee + Family $ 188.07 $ 407.49 $ 208.07 $ 450.82

Medical Surcharges

Employee Surcharges
Type of Surcharge
Wellness
Wellness
Tobacco
Tobacco
Both Plans
Biweekly
Monthly
Biweekly
Monthly
Employee Only
$ 20.00
$ 43.33
$ 25.00
$ 54.17

Dental

Employee Premiums DeltaCare USA HMO Biweekly Monthly Employee Only $ 5.43 $ 11.76 Employee + Children $ 11.85 $ 25.67
Employee + Spouse
$ 9.76
$ 21.14
Employee + Family
$ 18.30
$ 39.64
Employee Premiums
Low Option
Biweekly
Monthly
Employee Only
$ 6.91
$ 14.98
Employee + Children
$ 16.08
$ 34.85
Employee + Spouse
$ 13.75
$ 29.79
Employee + Family
$ 25.14
$ 54.47
High Option
Biweekly
Monthly
Employee Only
$ 16.68
$ 36.15
Employee + Children
$ 39.10
$ 84.71
Employee + Spouse
$ 33.22
$ 71.98
Employee + Family
$ 60.87
$ 131.88