2025 Employee Benefits Guide | Seite 9

Medical
Medical Surcharges
Dental
Vision

RATES

2025 EMPLOYEE PREMIUMS
January 1, 2025- September 30, 2025

Medical

Employee Premiums Wellness Wellness Non-Wellness Non-Wellness
HDHP 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
Copay 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
Base Plan Biweekly Monthly Employee Only $ 7.26 $ 15.72
Employee + Spouse
$ 14.40
$ 31.20
Employee + Children
$ 17.15
$ 37.16
Employee + Family $ 26.62 $ 57.68

Vision

Employee Premiums
Biweekly
Monthly
Employee Only
$ 2.13
$ 4.62
Employee + Spouse
$ 4.40
$ 9.54
Employee + Children
$ 5.21
$ 11.28
Employee + Family
$ 6.82
$ 14.78
Buy-Up Plan
Biweekly
Monthly
Employee Only
$ 18.52
$ 40.12
Employee + Spouse
$ 35.98
$ 77.96
Employee + Children
$ 44.94
$ 97.36
Employee + Family
$ 69.25
$ 150.04