JC - 2024 Employee Benefits Guide - (FINAL 11.28.2023) SPR

UNITEDHEALTHCARE (PPO) BI-WEEKLY MEDICAL CONTRIBUTIONS

CHOICE PLUS PPO PLAN (HIGH PLAN)

TIER

Employee

$250.33

Employee + Spouse

$723.16

Employee + Child(ren)

$524.22

Employee + Family

$1,041.58

UNITEDHEALTHCARE (HDHP) BI-WEEKLY MEDICAL CONTRIBUTIONS

UNITEDHEALTHCARE (HDHP) BI-WEEKLY MEDICAL CONTRIBUTIONS

CHOICE PLUS HSA PPO (LOW PLAN)

CHOICE PLUS HSA PPO (MIDDLE PLAN)

TIER

TIER

Employee

$47.05

Employee

$122.95

Employee + Spouse

$343.10

Employee + Spouse

$484.45

Employee + Child(ren)

$353.02

Employee + Child(ren)

$242.86

Employee + Family

$719.72

Employee + Family

$503.41

AMERITAS BI-WEEKLY DENTAL CONTRIBUTIONS

AMERITAS BI-WEEKLY VISION CONTRIBUTIONS

TIER

PPO PLAN

TIER

CHOICE NETWORK PLAN

Employee

$17.54

Employee

$3.40

Employee + Spouse

$34.52

Employee + Spouse

$7.59

Employee + Child(ren)

$41.52

Employee + Child(ren)

$6.17

Employee + Family

$58.51

Employee + Family

$10.36

3