Employee Contributions

The charts below list the amounts you will pay per pay period for coverage. It’s important to review your options and costs, and choose the coverage that’s right for you.

Medical Costs (Per Pay Period)

Coverage	Medical Plan
Employee Only	$69.23
Employee + One	$138.46
Employee + Two	$184.62
Employee + Three	$207.69
Employee + Four	$219.23
Employee + Five	$230.77
Employee + Six	$242.31
Employee + Seven	$253.85
Employee + Eight	$265.38
Employee + Nine	$276.92
Employee + Ten	$288.46
Employee + Eleven	$300.00
Employee + Twelve	$311.54

Dental Costs (Per Pay Period)

Coverage	UHC DHMO	UHC Low Plan	UHC High Plan
Employee Only	$6.06	$10.12	$18.11
Employee + Spouse	$12.11	$19.99	$34.64
Employee + Child(ren)	$15.75	$28.50	$49.19
Employee + Family	$21.20	$38.44	$53.93

Vision Costs (Per Pay Period)

Coverage	Exam Plus Plan	Enhanced Vision Plan
Employee Only	$0.45	$3.60
Employee + Spouse	$0.72	$5.04
Employee + Child(ren)	$0.86	$6.21
Employee + Family	$1.38	$9.92

Buy-up Short-Term and Optional Long-Term Disability Costs (Per Pay Period)

Buy-up Short-Term Disability		Optional Long-Term Disability
	Rate per $10 of Weekly Benefit	Age on 1/1/25	Rate per $100 of Monthly Base Pay
Buy-Up Plan	$0.060	Under 30	$0.069
		30 – 34	$0.102
		35 – 39	$0.152
		40 – 44	$0.254
		45 – 49	$0.369
		50 – 54	$0.517
		55 – 59	$0.637
		60+	$0.752

Accident Insurance (Per Pay Period)

Coverage	Low Plan	High Plan
Employee Only	$2.94	$5.12
Employee + Spouse	$4.69	$9.32
Employee + Child(ren)	$6.24	$10.90
Employee + Family	$9.50	$13.55

Critical Illness Insurance (Per Pay Period)

Employee Only	Option 1	Option 2	Option 3
Age on 1/1/2025	10,000	20,000	30,000
Under 25	$0.68	$1.37	$2.05
25 – 29	$0.94	$1.88	$2.82
30 – 34	$1.28	$2.57	$3.85
35 – 39	$1.56	$3.13	$4.69
40 – 44	$3.08	$6.17	$9.25
45 – 49	$5.14	$10.27	$15.41
50 – 54	$7.45	$14.90	$22.35
55 – 59	$10.32	$20.63	$30.95
60 – 64	$14.59	$29.19	$43.78
65 – 69	$19.95	$39.90	$59.84
70 – 74	$26.41	$52.82	$79.23
75+	$37.28	$74.57	$111.85

Employee + Spouse	Option 1	Option 2	Option 3
Age on 1/1/2025	10,000	20,000	30,000
Under 25	$1.32	$2.65	$3.97
25 – 29	$1.84	$3.68	$5.52
30 – 34	$2.52	$5.05	$7.57
35 – 39	$3.64	$7.27	$10.91
40 – 44	$6.08	$12.16	$18.24
45 – 49	$10.06	$20.11	$30.17
50 – 54	$14.55	$29.10	$43.66
55 – 59	$20.03	$40.06	$60.09
60 – 64	$28.63	$57.27	$85.90
65 – 69	$39.25	$78.50	$117.75
70 – 74	$52.09	$104.18	$156.27
75+	$71.65	$143.31	$214.96

Employee + Child	Option 1	Option 2	Option 3
Age on 1/1/2025	10,000	20,000	30,000
Under 25	$1.28	$2.57	$3.85
25 – 29	$1.54	$3.08	$4.62
30 – 34	$1.88	$3.77	$5.65
35 – 39	$2.16	$4.33	$6.49
40 – 44	$3.68	$7.37	$11.05
45 – 49	$5.74	$11.47	$17.21
50 – 54	$8.05	$16.10	$24.15
55 – 59	$10.92	$21.83	$32.75
60 – 64	$15.19	$30.39	$45.58
65 – 69	$20.55	$41.10	$61.64
70 – 74	$27.01	$54.02	$81.03
75+	$37.88	$75.77	$113.65

Employee + Family	Option 1	Option 2	Option 3
Age on 1/1/2025	10,000	20,000	30,000
Under 25	$1.92	$3.85	$5.77
25 – 29	$2.44	$4.88	$7.32
30 – 34	$3.12	$6.25	$9.37
35 – 39	$4.24	$8.47	$12.71
40 – 44	$6.68	$13.36	$20.04
45 – 49	$10.66	$21.31	$31.97
50 – 54	$15.15	$30.30	$45.46
55 – 59	$20.63	$41.26	$61.89
60 – 64	$29.23	$58.47	$87.70
65 – 69	$39.85	$79.70	$119.55
70 – 74	$52.69	$105.38	$158.07
75+	$72.25	$144.51	$216.76

Hospital Indemnity Insurance (Per Pay Period)

Employee Only	$4.87
Employee + Spouse	$13.26
Employee + Child(ren)	$11.36
Employee + Family	$21.15

Your Costs for Employee, Spouse and Dependent Supplemental Term Life Insurance (Per Pay Period)

The rates below are shown per pay period per $1,000 of coverage.

Age on 1/1/25	Employee Life: Non-Tobacco User¹	Employee Life: Tobacco User¹	Spouse Life²
Under 25	$0.016	$0.023	$0.015
25 – 29	$0.026	$0.037	$0.024
30 – 34	$0.026	$0.037	$0.024
35 – 39	$0.031	$0.053	$0.029
40 – 44	$0.045	$0.083	$0.042
45 – 49	$0.067	$0.130	$0.062
50 – 54	$0.104	$0.203	$0.099
55 – 59	$0.175	$0.312	$0.159
60 – 64	$0.269	$0.443	$0.244
65 – 69	$0.471	$0.680	$0.413
70+	$0.895	$1.272	$0.784

Supplemental Child(ren) Life (per $1,000 of coverage)
$0.092

¹ You are considered a “tobacco user” if you have used any tobacco products in the last 12 months.

² The rates for Employee Life and Spouse Life Insurance are based on each individual's age as of January 1, 2025. These rates will remain in effect for the entire calendar year.

Separate Rates for Tobacco and Non-Tobacco Users: If you are a non-tobacco user, your life insurance rates will be lower than if you use tobacco.

Supplemental AD&D (Per Pay Period)

The rates below are shown per pay period per $1,000 of coverage.

Employee	$0.014
Spouse	$0.009
Child(ren)	$0.012

Legal Plan (Per Pay Period)

Employee + Family	$7.36

Identity Theft Protection (Per Pay Period)

Employee Only	$4.84
Employee + Family	$8.07