2017 B E NEFIT C O NTRI BUTIO NS PER PAY PERIO D FOR A DMI NIST RATO RS / S TAFF
Emblem EPO
Employer Monthly Cost
$991.52
$2,082.18
$1,883.89
$2,974.56
Salary Bands
Individual
Employee+Spouse
Employee+Children
Family
Under $29,999
$74.82
$157.13
$142.16
$224.46
$30,000 - $49,999
$84.89
$178.17
$161.29
$254.67
$50,000 - $69,000
$92.40
$194.03
$175.55
$277.18
$70,000 - $89,999
$94.91
$199.31
$180.33
$284.73
$90,000 - $109,999
$99.95
$209.88
$189.81
$299.70
$110,000 - $129,999
$107.45
$225.65
$204.16
$343.36
Over $130,000
$119.99
$251.98
$227.98
$359.97
Employer Monthly Cost
$1,156.31
$2,254.80
$3,353.30
Salary Bands
Individual
Employee+One
Family
Under $29,999
$87.26
$170.15
$253.04
$30,000 - $49,999
$99.00
$193.05
$287.10
$50,000 - $69,000
$107.75
$210.11
$306.60
$70,000 - $89,999
$110.69
$215.84
$320.99
$90,000 - $109,999
$122.37
$238.63
$354.88
$110,000 - $129,999
$131.18
$255.80
$380.42
Over $130,000
$139.93
$272.87
$405.80
Empire BCBS Direct HMO
Guardian Dental DMO & PPO
Individual
Employee+ Spouse
Employee+Children
Family
DHMO
$0.00
$8.06
$8.61
$16.62
PPO
$10.21
$28.56
$25.58
$43.93
Empire Blue Vision Eyeglass
Individual: $2.64
Family: $6.88
Confidential & Proprietary Information
2017 M E DI CAL C ONT RI BUTIO NS PER PAY PERIO D FOR F ACULTY
Emblem EPO
Employer
Monthly Cost
$991.52
$2,082.18
$1,883.89
$2,974.56
Salary Bands
Individual
Employee+Spouse
Employee+Children
Family
$50,000 - $69,000
$100.10
$210.20
$190.18
$300.28
$70,000 - $89,999
$102.82
$215.92
$195.36
$308.46
$90,000 - $109,999
$108.28
$227.27
$205.63
$349.22
$110,000 - $129,999
$116.41
$244.45
$221.17
$371.97
Over $130,000
$129.99
$272.98
$246.98
$389.97
Employer
Monthly Cost
$1,156.31
$2,254.80
$3,353.30
Salary Bands
Individual
Employee+One
Family
$50,000 - $69,000
$116.73
$227.62
$338.52
$70,000 - $89,999
$119.91
$233.83
$347.74
$90,000 - $109,999
$132.57
$258.52
$384.46
$110,000 - $129,999
$142.11
$277.12
$412.12
Over $130,000
$151.59
$295.61
$439.62
Empire BCBS Direct HMO
Guardian DMO & PPO
Individual
Employee+Spouse
Employee+Children Family
DHMO
$0.00
$8.73
$9.33
$18.00
PPO
$11.07
$30.94
$27.72
$47.59
Empire Blue Vision Eyeglass
Individual: $2.87
Family: $7.45
Confidential & Proprietary Information