Your payroll contributions for medical, dental and vision benefits are shown here. The premiums you pay are based on the plan you select, your salary band and coverage level. Your salary band is based on your current annual base earnings. Even if your annual base earnings increases after you enroll, your salary band will not change until next year’s Open Enrollment.
| 2025 HSA Plan Rates | ||||||
|---|---|---|---|---|---|---|
| Salary <$50,000 | Salary $50,000 - $100,000 | Salary >$100,000 | ||||
| Weekly | Bi-Weekly | Weekly | Bi-Weekly | Weekly | Bi-Weekly | |
| Employee Only | $19.34 | $38.68 | $21.04 | $42.09 | $21.04 | $42.09 |
| Employee + Spouse | $65.24 | $130.49 | $104.96 | $209.91 | $111.98 | $223.95 |
| Employee + Child(ren) | $53.38 | $106.76 | $85.87 | $171.74 | $91.62 | $183.23 |
| Employee + Family | $91.93 | $183.86 | $147.89 | $295.78 | $157.79 | $315.57 |
| 2025 HRA Plan Rates | ||||||
|---|---|---|---|---|---|---|
| Salary <$50,000 | Salary $50,000 - $100,000 | Salary >$100,000 | ||||
| Weekly | Bi-Weekly | Weekly | Bi-Weekly | Weekly | Bi-Weekly | |
| Employee Only | $41.69 | $83.39 | $42.81 | $85.62 | $42.81 | $85.62 |
| Employee + Spouse | $114.44 | $228.87 | $154.15 | $308.30 | $159.88 | $319.75 |
| Employee + Child(ren) | $93.63 | $187.26 | $126.12 | $252.24 | $130.81 | $261.62 |
| Employee + Family | $161.25 | $322.49 | $217.20 | $434.41 | $225.28 | $450.56 |
| 2025 PPO Plan Rates | ||||||
|---|---|---|---|---|---|---|
| Salary <$50,000 | Salary $50,000 - $100,000 | Salary >$100,000 | ||||
| Weekly | Bi-Weekly | Weekly | Bi-Weekly | Weekly | Bi-Weekly | |
| Employee Only | $66.38 | $132.76 | $66.84 | $133.68 | $66.84 | $133.68 |
| Employee + Spouse | $168.71 | $337.43 | $208.43 | $416.85 | $212.73 | $425.45 |
| Employee + Child(ren) | $138.04 | $276.07 | $170.53 | $341.06 | $174.04 | $348.09 |
| Employee + Family | $237.73 | $475.46 | $293.69 | $587.38 | $299.75 | $599.50 |
| 2025 Dental Plan Rates | ||||||
|---|---|---|---|---|---|---|
| High Plan | Low Plan | DHMO | ||||
| Weekly | Bi-Weekly | Weekly | Bi-Weekly | Weekly | Bi-Weekly | |
| Employee Only | $9.07 | $18.14 | $7.85 | $15.70 | $3.37 | $6.74 |
| Employee + 1 | $21.66 | $43.32 | $16.02 | $32.04 | $6.88 | $13.76 |
| Employee + 2 | $31.44 | $62.87 | $24.67 | $49.35 | $10.59 | $21.17 |
| 2025 Vision Plan Rates | ||||||
|---|---|---|---|---|---|---|
| Weekly | Bi-Weekly | |||||
| Employee Only | $1.72 | $3.45 | ||||
| Employee + 1 | $3.18 | $6.36 | ||||
| Employee + 2 | $4.51 | $9.02 | ||||
