
| BCBSTX Medical Rates | |
|---|---|
| HDHP + HSA | |
| Coverage Level | Biweekly Rates |
| Employee Only | $41.74 |
| Employee + Spouse | $166.58 |
| Employee + Child(ren) | $124.45 |
| Employee + Family | $243.43 |
| MID-PPO PLAN | |
| Coverage Level | Biweekly Rates |
| Employee Only | $67.83 |
| Employee + Spouse | $228.54 |
| Employee + Child(ren) | $178.12 |
| Employee + Family | $332.21 |
| HYBRID PLAN | |
| Coverage Level | Biweekly Rates |
| Employee Only | $100.87 |
| Employee + Spouse | $291.03 |
| Employee + Child(ren) | $236.96 |
| Employee + Family | $421.02 |
| Kaiser Medical Rates | |
| HDHP + HSA | |
| Coverage Level | Biweekly Rates |
| Employee Only | $52.68 |
| Employee + Spouse | $186.58 |
| Employee + Child(ren) | $143.54 |
| Employee + Family | $273.52 |
| MID-PPO PLAN | |
| Coverage Level | Biweekly Rates |
| Employee Only | $76.17 |
| Employee + Spouse | $240.30 |
| Employee + Child(ren) | $190.68 |
| Employee + Family | $350.40 |
| Guardian Dental Rates | |
| Dental PPO | |
| Coverage Level | Biweekly Rates |
| Employee Only | $8.04 |
| Employee + Spouse | $15.39 |
| Employee + Child(ren) | $14.52 |
| Employee + Family | $23.57 |
| VSP Vision Rates | |
| VSP | |
| Coverage Level | Biweekly Rates |
| Employee Only | $1.92 |
| Employee + Spouse | $3.85 |
| Employee + Child(ren) | $4.13 |
| Employee + Family | $6.59 |
| Guardian Optional Life & AD&D Rates - Employee/Spouse | ||
|---|---|---|
| Age | Per $10,000 | |
| Under 25 | $0.09 | |
| 25-29 | $0.09 | |
| 30-34 | $0.10 | |
| 35-39 | $0.13 | |
| 40-44 | $0.18 | |
| 45-49 | $0.28 | |
| 50-54 | $0.44 | |
| 55-59 | $0.75 | |
| 60-64 | $0.86 | |
| 65-69 | $1.43 | |
| 70-74 | $2.17 | |
| 75+ | $5.25 | |
| Critical Illness Insurance Biweekly Rates | ||||||
|---|---|---|---|---|---|---|
| Benefit Amount Employee | <30 | 30-39 | 40-49 | 50-59 | 60-69 | 70+ |
| $5,000 | $0.85 | $1.36 | $2.65 | $5.42 | $9.44 | $16.15 |
| $10,000 | $1.71 | $2.72 | $5.31 | $10.85 | $18.88 | $32.31 |
| $15,000 | $2.56 | $4.08 | $7.96 | $16.27 | $28.32 | $48.46 |
| $20,000 | $3.42 | $5.45 | $10.62 | $21.69 | $37.75 | $64.62 |
| $25,000 | $4.27 | $6.81 | $13.27 | $27.12 | $47.19 | $80.77 |
| $30,000 | $5.12 | $8.71 | $15.92 | $32.54 | $56.63 | $96.92 |
| Critical Illness Insurance Biweekly Rates | ||||||
|---|---|---|---|---|---|---|
| Benefit Amount Spouse | <30 | 30-39 | 40-49 | 50-59 | 60-69 | 70+ |
| $2,500 | $0.43 | $0.68 | $1.33 | $2.71 | $4.72 | $8.08 |
| $5,000 | $0.85 | $1.36 | $2.65 | $5.42 | $9.44 | $16.15 |
| $7,500 | $1.28 | $2.04 | $3.98 | $8.14 | $14.16 | $24.23 |
| $10,000 | $1.71 | $2.72 | $5.31 | $10.85 | $18.88 | $32.31 |
| $12,500 | $2.14 | $3.41 | $6.64 | $13.56 | $23.60 | $40.38 |
| $15,000 | $2.56 | $4.08 | $7.96 | $16.27 | $28.32 | $48.46 |
| Coverage Level | Accident Insurance Biweekly Rates |
|---|---|
| Employee only | $4.86 |
| Employee and spouse | $8.14 |
| Employee and child(ren) | $8.50 |
| Employee and family | $11.77 |
| Coverage Level | Hospital Indemnity Insurance Biweekly Rates |
|---|---|
| Employee only | $4.61 |
| Employee and spouse | $14.73 |
| Employee and child(ren) | $9.64 |
| Employee and family | $19.75 |
| Guardian Optional Life Insurance Rates - Child | ||
|---|---|---|
| Age | Per $10,000 | |
| Per child(ren) | $5,000 or $10,000 in coverage: $0.16 per $1,000 of coverage | |
| Optional AD&D (Employee, Spouse, and Child(ren) | ||
|---|---|---|
| $0.050 per $1,000 of coverage | ||
| Optional Disability (Non-Executive/Non-Office Employees) | ||
|---|---|---|
| STD per $10 in weekly benefit | LTD per $100 of covered payroll | |
| $0.30 | $0.55 | |