Davis Behavioral Health 2024-2025 Benefit Guide | Page 4

Semi-monthly ( 24 pay periods )

Benefit Plan

Premium Per Month

Employer Per Pay Period

Employee Per Pay Period ( Met SHARE wellness requirements )

Employee Per Pay Period ( Did NOT meet SHARE requirements )

MEDICAL — TRADITIONAL FULL-TIME

Employee

$ 718.90

$ 287.56

$ 71.89

$ 93.46

Employee + 1

$ 1 , 487.90

$ 595.16

$ 148.79

$ 193.43

Family

$ 2 , 012.70

$ 805.08

$ 201.27

$ 261.65

MEDICAL — HIGH DEDUCTIBLE FULL-TIME

Employee

$ 610.90

$ 262.69

$ 42.76

$ 55.59

Employee + 1

$ 1,264.50

$ 543.74

$ 88.52

$ 115.07

Family

$ 1,710.20

$ 735.39

$ 119.71

$ 155.63

Benefit Plan

Premium Per Month

Employer Per Pay Period

Employee Per Pay Period

DENTAL — FULL-TIME Employee

$ 46.40

$ 11.60

$ 11.60

Employee + 1

$ 83.76

$ 20.94

$ 20.94

Family

$ 118.26

$ 29.57

$ 29.57

VISION Employee

$ 9.06

NA

$ 4.53

Employee + 1

$ 13.14

NA

$ 6.57

Family

$ 23.55

NA

$ 11.78

HSA ANNUAL CONTRIBUTIONS

FSA and HSA deductions are deducted on a bi-weekly ( 26 pay period ) basis .

Employer Contribution

Employer Match

Employee Match

Employee

$ 520

$ 600

$ 600

Employee + 1

$ 780

$ 900

$ 900

Family

$ 1,040

$ 1,200

$ 1,200

VOLUNTARY ACCIDENT

VOLUNTARY IDENTITY THEFT PROTECTION

Employee

$ 6.42

Employee

$ 4.48

Employee + Spouse

$ 11.17

Employee + Spouse

$ 8.48

Employee + Child ( ren )

$ 13.96

Employee + Child ( ren )

$ 8.48

Family

$ 20.49

Family

$ 8.48

VOLUNTARY HOSPITAL INDEMNITY

Employee

$ 7.40

Employee + Spouse

$ 15.01

Employee + Child ( ren )

$ 14.09

Family

$ 21.69