Benefits Rate Sheet
PPO
| PPO | Employee | EE+ Spouse | EE+Child(ren) | Family |
|---|---|---|---|---|
| Employee Cost | $203 | $692 | $597 | $927 |
HDP + H.S.A.
| HDP + H.S.A. | Employee | EE+ Spouse | EE+Child(ren) | Family |
|---|---|---|---|---|
| District Contribution H.S.A. | $50 | $75 | $75 | $75 |
| Employee Cost | $129 | $581 | $501 | $779 |
Dental
| Dental | Employee | EE+ Spouse | EE+Child(ren) | Family |
|---|---|---|---|---|
| Total Premium | $38.85 | $79.66 | $85.76 | $150.90 |
| District Contribution | $38.85 | $38.85 | $38.85 | $38.85 |
| Employee Cost | $0 | $40.81 | $46.91 | $112.05 |
Vision
| Vision | Employee | EE+ Spouse | EE+Child(ren) | Family |
|---|---|---|---|---|
| Total Premium | $5.98 | $12.94 | $13.92 | $22.82 |
| District Contribution | $5.98 | $5.98 | $5.98 | $5.98 |
| Employee Cost | $0 | $6.96 | $7.94 | $16.84 |
Other
Life - 1x annual salary, paid 100% by district.
Long term disability - paid 100% by district.