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2015-2016

EMPLOYEE RATE WORKSHEET Use this worksheet to provide a general estimate of your benefits costs for the upcoming plan year. This is a great place to start planning for you and your family’s health and wellness for next year.

MONTHLY INSURANCE RATES FOR 2015-2016 PLAN YEAR MEDICAL PLAN DENTAL PLAN

VISION PLAN

HDHP

CLASSIC GOLD COPAY GOLD

PP0

EDS

AVESIS

$267.00

$346.00

$565.00

$37.00

$9.79

$6.51

EMPLOYEE & SPOUSE $548.00

$723.00

$1,155.00

$75.00

$22.78

$10.70

EMPLOYEE & DOMESTIC $548.00 PARTNER*

$723.00

$1,155.00

$75.00

$22.78

$10.70

EMPLOYEE & CHILDREN $522.00

$688.00

$1,097.00

$77.00

$30.36

$11.07

EMPLOYEE & FAMILY

$758.00

$1,002.00

$1,598.00

$99.00

$32.86

$17.57

EMPLOYEE & DOMESTIC $758.00 PARTNER & CHILDREN*

$1,002.00

$1,598.00

$99.00

$32.86

$17.57

EMPLOYEE ONLY

DISTRICT’S CONTRIBUTION EMPLOYMENT STATUS CONTRIBUTION

HSA

HSA

0.8 - 1.0 FTE 0.64 – 0.79 FTE 0.50 – 0.63 FTE

$1000 ANNUALLY $750 ANNUALLY $500 ANNUALLY

$83.33 MONTHLY $62.50 MONTHLY $41.67 MONTHLY

*Please note that deductions for domestic partner premiums are post-tax. IRS section 125 tax law prohibits a pre-tax insurance deduction for domestic partner coverage.

$4,152 ANNUALLY $3,114 ANNUALLY $2,076 ANNUALLY

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MUSD Employee Benefit Guide 2015  

MUSD Employee Benefit Guide 2015  

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