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Health Insurance Premiums

Effective October 1, 2014

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Blue Cross/Blue Shield (BCBS)

Presbyterian Health Plan

United Dental/Concordia

Davis Vision

 


Blue Cross/Blue Shield (BCBS)

High Option

Total Monthly Premium Cost

$560.06

$1,065.14

$1,422.62

Bi-Weekly Payroll Deduction: 396 or 391

Single

Two-Party

Family

Employee Status

Annualized Salary

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Full-time

Less than 24,999.99

SC

$56.01

$224.02

TC

$106.51

$426.06

FC

$142.26

$569.05

$25000 and above

SD

$70.01

$210.02

TD

$133.14

$399.43

FD

$177.83

$533.48

Three-Quarter time

Less than $19,999.99

SF

$106.41

$173.62

TF

$202.38

$330.19

FF

$270.30

$441.01

$20,000 to 24,999.99

SG

$112.01

$168.02

TG

$213.03

$319.54

FG

$284.52

$426.79

$25000 and above

SH

$122.51

$157.52

TH

$233.00

$299.57

FH

$311.20

$400.11

Half-time

Less than $19,999.99

SJ

$154.02

$126.01

TJ

$292.91

$239.66

FJ

$391.22

$320.09

$20,000 to 24,999.99

SK

$162.42

$117.61

TK

$308.89

$223.68

FK

$412.56

$298.75

$25000 and above

SL

$168.02

$112.01

TL

$319.54

$213.03

FL

$426.79

$284.52

Low Option

Total Monthly Premium Cost

$470.44

$894.70

$1,195.06

Bi-Weekly Payroll Deduction: 376 or 371

Single

Two-Party

Family

Employee Status

Annualized Salary

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Full-time

Less than 24,999.99

SC

$47.04

$188.18

TC

$89.47

$357.88

FC

$119.51

$478.02

$25000 and above

SD

$58.81

$176.41

TD

$111.84

$335.51

FD

$149.38

$448.15

Three-Quarter time

Less than $19,999.99

SF

$89.38

$145.84

TF

$169.99

$277.36

FF

$227.06

$370.47

$20,000 to 24,999.99

SG

$94.09

$141.13

TG

$178.94

$268.41

FG

$239.01

$358.52

$25000 and above

SH

$102.91

$132.31

TH

$195.72

$251.63

FH

$261.42

$336.11

Half-time

Less than $19,999.99

SJ

$129.37

$105.85

TJ

$246.04

$201.31

FJ

$328.64

$268.89

$20,000 to 24,999.99

SK

$136.43

$98.79

TK

$259.46

$187.89

FK

$346.57

$250.96

$25000 and above

SL

$141.13

$94.09

TL

$268.41

$178.94

FL

$358.52

$239.01

 

 

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Presbyterian Health Plan

High Option

Total Monthly Premium Cost

$452.92

$951.02

$1,268.16

Bi-Weekly Payroll Deduction: 398 or 393

Single

Two-Party

Family

Employee Status

Annualized Salary

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Full-time

Less than 24,999.99

SC

$45.29

$181.17

TC

$95.10

$380.41

FC

$126.82

$507.26

$25000 and above

SD

$56.62

$169.84

TD

$118.88

$356.63

FD

$158.52

$475.56

Three-Quarter time

Less than $19,999.99

SF

$86.05

$140.41

TF

$180.69

$294.82

FF

$240.95

$393.13

$20,000 to 24,999.99

SG

$90.58

$135.88

TG

$190.20

$285.31

FG

$253.63

$380.45

$25000 and above

SH

$99.08

$127.38

TH

$208.04

$267.47

FH

$277.41

$356.67

Half-time

Less than $19,999.99

SJ

$124.55

$101.91

TJ

$261.53

$213.98

FJ

$348.74

$285.34

$20,000 to 24,999.99

SK

$131.35

$95.11

TK

$275.80

$199.71

FK

$367.77

$266.31

$25000 and above

SL

$135.88

$90.58

TL

$285.31

$190.20

FL

$380.45

$253.63

Low Option

Total Monthly Premium Cost

$380.48

$798.88

$1,065.24

Bi-Weekly Payroll Deduction: 378 or 373

Single

Two-Party

Family

Employee Status

Annualized Salary

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Full-time

Less than 24,999.99

SC

$38.05

$152.19

TC

$79.89

$319.55

FC

$106.52

$426.10

$25000 and above

SD

$47.56

$142.68

TD

$99.86

$299.58

FD

$133.16

$399.46

Three-Quarter time

Less than $19,999.99

SF

$72.29

$117.95

TF

$151.79

$247.65

FF

$202.40

$330.22

$20,000 to 24,999.99

SG

$76.10

$114.14

TG

$159.78

$239.66

FG

$213.05

$319.57

$25000 and above

SH

$83.23

$107.01

TH

$174.76

$224.68

FH

$233.02

$299.60

Half-time

Less than $19,999.99

SJ

$104.63

$85.61

TJ

$219.16

$179.75

FJ

$292.94

$239.68

$20,000 to 24,999.99

SK

$110.34

$79.90

TK

$231.68

$167.76

FK

$308.92

$223.70

$25000 and above

SL

$114.14

$76.10

TL

$239.66

$159.78

FL

$319.57

$213.05

 

 

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United Dental/Concordia

High Option

Total Monthly Premium Cost

$27.24

$51.86

$81.48

Bi-Weekly Payroll Deduction: 365 or 360

Single

Two-Party

Family

Employee Status

Annualized Salary

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Full-time

Less than 24,999.99

SC

$2.72

$10.90

TC

$5.19

$20.74

FC

$8.15

$32.59

$25000 and above

SD

$3.41

$10.21

TD

$6.48

$19.45

FD

$10.19

$30.55

Three-Quarter time

Less than $19,999.99

SF

$5.18

$8.44

TF

$9.85

$16.08

FF

$15.48

$25.26

$20,000 to 24,999.99

SG

$5.45

$8.17

TG

$10.37

$15.56

FG

$16.30

$24.44

$25000 and above

SH

$5.96

$7.66

TH

$11.34

$14.59

FH

$17.82

$22.92

Half-time

Less than $19,999.99

SJ

$7.49

$6.13

TJ

$14.26

$11.67

FJ

$22.41

$18.33

$20,000 to 24,999.99

SK

$7.90

$5.72

TK

$15.04

$10.89

FK

$23.63

$17.11

$25000 and above

SL

$8.17

$5.45

TL

$15.56

$10.37

FL

$24.44

$16.30

Low Option

 

Total Monthly Premium Cost

$13.64

$25.96

$40.74

Bi-Weekly Payroll Deduction: 365 or 360

Single

Two-Party

Family

Employee Status

Annualized Salary

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Full-time

Less than 24,999.99

SC

$1.36

$5.46

TC

$2.60

$10.38

FC

$4.07

$16.30

$25000 and above

SD

$1.71

$5.11

TD

$3.25

$9.73

FD

$5.09

$15.28

Three-Quarter time

Less than $19,999.99

SF

$2.59

$4.23

TF

$4.93

$8.05

FF

$7.74

$12.63

$20,000 to 24,999.99

SG

$2.73

$4.09

TG

$5.19

$7.79

FG

$8.15

$12.22

$25000 and above

SH

$2.98

$3.84

TH

$5.68

$7.30

FH

$8.91

$11.46

Half-time

Less than $19,999.99

SJ

$3.75

$3.07

TJ

$7.14

$5.84

FJ

$11.20

$9.17

$20,000 to 24,999.99

SK

$3.96

$2.86

TK

$7.53

$5.45

FK

$11.81

$8.56

$25000 and above

SL

$4.09

$2.73

TL

$7.79

$5.19

FL

$12.22

$8.15

 

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Davis Vision

Total Monthly Premium Cost

$6.26

$10.48

$14.14

Bi-Weekly Payroll Deduction: 385 or 380

Single

Two-Party

Family

Employee Status

Annualized Salary

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Employee Portion

CNM Portion

Full-time

Less than 24,999.99

SC

$0.63

$2.50

TC

$1.05

$4.19

FC

$1.41

$5.66

$25000 and above

SD

$0.78

$2.35

TD

$1.31

$3.93

FD

$1.77

$5.30

Three-Quarter time

Less than $19,999.99

SF

$1.19

$1.94

TF

$1.99

$3.25

FF

$2.69

$4.38

$20,000 to 24,999.99

SG

$1.25

$1.88

TG

$2.10

$3.14

FG

$2.83

$4.24

$25000 and above

SH

$1.37

$1.76

TH

$2.29

$2.95

FH

$3.09

$3.98

Half-time

Less than $19,999.99

SJ

$1.72

$1.41

TJ

$2.88

$2.36

FJ

$3.89

$3.18

$20,000 to 24,999.99

SK

$1.82

$1.31

TK

$3.04

$2.20

FK

$4.10

$2.97

$25000 and above

SL

$1.88

$1.25

TL

$3.14

$2.10

FL

$4.24

$2.83

 

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