2004 Per Pay Benefit Costs

See the chart below for your share of the cost of the benefit plan options per pay period under the various coverage options.  Your cost will be deducted pre-tax from each of your paychecks.

FULL-TIME RATES
 
Medical
Dental
Vision
 
PPO - High
PPO - Middle
PPO - Low

HealthPartners HMO

Delta

VSP
 

24 Pays

26 Pays

24 Pays

26 Pays

24 Pays

26 Pays

24 Pays

26 Pays

24 Pays

26 Pays

24 Pays

26 Pays

Employee Only
$49.46
$45.65
$43.01
$39.70
$21.51
$19.85
$41.73
$38.52

$4.25
$3.92
$4.60
$4.25

Employee & Spouse
$109.32
$100.91
$95.06
$87.74
$47.53
$43.87
$89.11
$82.26
$8.75
$8.08
$7.24
$6.68

Employee & Child(ren)
$100.11
$92.40
$87.05
$80.35
$43.53
$40.18
$84.90
$78.36
$11.00
$10.15
$7.40
$6.83

Family
$141.54
$130.65
$123.08
$113.61
$61.54
$56.81
$120.70
$111.42
$13.50
$12.46
$11.92
$11.00

You & Domestic Partner
$109.32
$100.91
$95.06
$87.74
$47.53
$43.87
$89.11
$82.26
$8.75
$8.08
$7.24
$6.68

You, Domestic Partner & Child(ren)
$141.54
$130.65
$123.08
$113.61
$61.54
$56.81
$120.70
$111.42
$13.50
$12.46
$11.92
$11.00

PART-TIME

Employee Only
$98.91
$91.30
$86.01
$79.39
$43.01
$39.70
$83.45
$77.03
$8.50
$7.85
$4.60
$4.25

Employee & Spouse
$218.63
$201.81
$190.11
$175.49
$95.06
$87.75
$178.22
$164.51
$17.50
$16.15
$7.24
$6.68

Employee & Child(ren)
$200.21
$184.81
$174.10
$160.71
$87.05
$80.35
$169.79
$156.73
$22.00
$20.31
$7.40
$6.83

Family
$283.08
$261.30
$246.16
$227.22
$123.08
$113.61
$241.40
$222.83
$27.00
$24.92
$11.92
$11.00

You & Domestic Partner
$218.63
$201.81
$190.11
$175.49
$95.06
$87.75
$178.22
$164.51
$17.50
$16.15
$7.24
$6.68

You, Domestic Partner & Child(ren)
$283.08
$261.30
$246.16
$227.22
$123.08
$113.61
$241.40
$222.83
$27.00
$24.92
$11.92
$11.00