Rate Sheet Associate

MONTECARE EPO/MONTECARE PPO BI-WEEKLY PREMIUMS

SALARY BAND UNDER $39,999

Full-time You Only

MonteCare EPO - $48.71
MonteCare PPO - $74.77

Full-time You and Your Family

MonteCare EPO - $136.39
MonteCare PPO - $209.34

Part-time You Only

MonteCare EPO - $63.34
MonteCare PPO - $139.43

Part-time You and Your Family

MonteCare EPO - $313.99
MonteCare PPO - $390.38

SALARY BAND $40,000 • $64,999

Full-time You Only

MonteCare EPO - $55.88
MonteCare PPO - $81.94

Full-time You and Your Family

MonteCare EPO - $156.45
MonteCare PPO - $229.40

Part-time You Only

MonteCare EPO - $117.40
MonteCare PPO - $144.68

Part-time You and Your Family

MonteCare EPO - $328.70
MonteCare PPO - $405.09

SALARY BAND $65,000 • $99,999

 

Full-time You Only
 
MonteCare EPO - $69.49
MonteCare PPO - $105.22

Full-time You and Your Family

MonteCare EPO - $194.58
MonteCare PPO - $294.59

Part-time You Only

MonteCare EPO - $135.21
MonteCare PPO - $173.20

 

Part-time You and Your Family
MonteCare EPO - $378.58
MonteCare PPO - $484.98

SALARY BAND $100,000 • $149,999

Full-time You Only

MonteCare EPO - $82.13
MonteCare PPO - $121.03

Full-time You and Your Family

MonteCare EPO - $229.964
MonteCare PPO - $338.87

Part-time You Only

MonteCare EPO - $144.47
MonteCare PPO - $184.81

Part-time You and Your Family

MonteCare EPO - $404.53
MonteCare PPO - $517.45

SALARY BAND $150,000 • $199,999

Full-time You Only

MonteCare EPO - $88.45
MonteCare PPO - $127.94

Full-time You and Your Family

MonteCare EPO - $247.66
MonteCare PPO - $358.20

Part-time You Only

MonteCare EPO - $149.10
MonteCare PPO - $189.87

Part-time You and Your Family

MonteCare EPO - $417.49
MonteCare PPO - $531.62

SALARY BAND $200,000 • $249,999

Full-time You Only

MonteCare EPO - $94.76
MonteCare PPO - $136.09

Full-time You and Your Family

MonteCare EPO - $265.35
MonteCare PPO - $381.07

Part-time You Only

MonteCare EPO - $153.74
MonteCare PPO - $195.86

Part-time You and Your Family

MonteCare EPO - $430.47
MonteCare PPO - $548.40

SALARY BAND $250,000 AND OVER

Full-time You Only

MonteCare EPO - $101.08
MonteCare PPO - $143.06

Full-time You and Your Family

MonteCare EPO - $283.03
MonteCare PPO - $400.56.89

Part-time You Only

MonteCare EPO - $158.37
MonteCare PPO - $200.96

Part-time You and Your Family

MonteCare EPO - $443.44
MonteCare PPO - $562.68

UNITEDHEALTHCARE VISION PLAN

LOW OPTION

You Only

$2.30

You and One Family Member

$4.10

You and Your Family

$6.95

HIGH OPTION

 

You Only

$3.54

You and One Family Member

$6.79

You and Your Family

$9.39

DENTAL

CIGNA DHMO

You Only

$7.68

You and Your Family

$19.22

PREVENTIVE & DIAGNOSTIC DENTAL CARE ONLY

You Only

Your first year at Montefiore • $3.37
After your first year at Montefiore • $0

You and Your Family

Your first year at Montefiore • $9.43
After your first year at Montefiore • $0

CIGNA DPPO DENTAL PLAN

You Only

Your first year at Montefiore • $17.76
After your first year at Montefiore • $8.52

You and Your Family

Your first year at Montefiore • $49.71
After your first year at Montefiore • $27.84

CIGNA DPPO ENHANCED DENTAL PLAN

You Only

Your first year at Montefiore • $24.12
After your first year at Montefiore • $14.89

You and Your Family

Your first year at Montefiore • $67.53
After your first year at Montefiore • $45.66

LIFE INSURANCE

Basic Life Insurance

Montefiore provides Basic Life Insurance – at no cost to you after you complete one year at Montefiore.

  • Your Basic Life Insurance monthly premium is $0.08 for every $1,000 of your annual base salary.
  • If you elect to opt down to $50,000, your monthly premium is $4.00 ($1.85 bi-weekly).

Supplemental Life Insurance

Under 25 Age Group

Non-nicotine user

$0.025 per $1,000

Nicotine user

$0.027 per $1,000

25-29 Age Group

Non-nicotine user

$0.027 per $1,000

Nicotine user

$0.029 per $1,000

30-34 Age Group

Non-nicotine user

$0.034 per $1,000

Nicotine user

$0.037 per $1,000

35-39 Age Group

Non-nicotine user

$0.043 per $1,000

Nicotine user

$0.045 per $1,000

40-44 Age Group

Non-nicotine user

$0.056 per $1,000

Nicotine user

$0.061 per $1,000

45-49 Age Group

Non-nicotine user

$0.089 per $1,000

Nicotine user

$0.098 per $1,000

50-54 Age Group

Non-nicotine user

$0.142 per $1,000

Nicotine user

$0.158 per $1,000

55-59 AGE GROUP

Non-nicotine user

$0.243 per $1,000

Nicotine user

$0.270 per $1,000

60-64 AGE GROUP

Non-nicotine user

$0.345 per $1,000

Nicotine user

$0.383 per $1,000

65-69 AGE GROUP

Non-nicotine user

$0.583 per $1,000

Nicotine user

$0.647 per $1,000

70+ Age Group

Non-nicotine user

$0.916 per $1,000

Nicotine user

$1.017 per $1,000
 

Supplemental Life Insurance Premium Calculator

1. Enter your Annual Base Salary

2. Enter your Contribution Rate per $1,000 based on your age and nicotine user/non-nicotine user (from chart)

3. Select a Voluntary Life Option from 1 to 8

4. Your cost per paycheck

Dependent Life Insurance

If you elect Dependent Life Insurance, the bi-weekly cost is:

  • $1.49 – $10,000 for your spouse; $5,000 for each child
  • $2.97 – $20,000 for your spouse; $10,000 for each child.

AD&D INSURANCE

Basic AD&D

Montefiore provides Basic AD&D Insurance – at no cost to you after you complete one year at Montefiore. Your Basic AD&D Insurance monthly premium is $0.014 for every $1,000 of your annual base salary.

Supplemental AD&D

For every $1,000 of coverage you elect, your Supplemental AD&D monthly premium is based on:

  • $0.018 for yourself
  • $0.018 for your spouse
  • $0.015 for each child.

GROUP LEGAL SERVICES

If you elect Group Legal Services, the bi-weekly cost is:

  • $3.80 for yourself
  • $5.19 for you and your family.