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
$7.45
You and Your Family
$18.65
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
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.