Rate Sheet House Staff

MonteCare PPO Bi-weekly Premiums (non-nicotine user rates)

MonteCare PPO Stipend Band Under $39,999

Full-time You Only

$74.77

Full-time You and Your Family

$209.43

Part-time You Only

$139.43

Part-time You and Your Family

$390.38

MonteCare PPO Stipend Band $40,000 – $64,999

Full-time You Only

$81.94

Full-time You and Your Family

$229.40

Part-time You Only

$144.68

Part-time You and Your Family

$405.09

MonteCare PPO Stipend Band $65,000 – $99,999

Full-time You Only

$92.66

Full-time You and Your Family

$259.44

Part-time You Only

$152.64

Part-time You and Your Family

$427.12

MonteCare PPO Stipend Band $100,000 – $149,999

Full-time You Only

$106.95

Full-time You and Your Family

$298.44

Part-time You Only

$162.76

Part-time You and Your Family

$455.71

MonteCare PPO Stipend Band $150,000 – $199,999

Full-time You Only

$112.67

Full-time You and Your Family

$315.46

Part-time You Only

$167.22

Part-time You and Your Family

$468.19

MonteCare PPO Stipend Band $200,000 – $249,999

Full-time You Only

$119.86

Full-time You and Your Family

$335.61

Part-time You Only

$172.49

Part-time You and Your Family

$482.97

MonteCare PPO Stipend Band $250,000 and over

Full-time You Only

$125.99

Full-time You and Your Family

$352.77

Part-time You Only

$176.98

Part-time You and Your Family

$495.55

UNITEDHEALTHCARE VISION PLAN - BI-WEEKLY PREMIUMS

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 BI-WEEKLY PREMIUMS

Cigna DHMO

Cigna DHMO – You Only

$0

Cigna DHMO – You and Your Family

$0

Preventive & Diagnostic Dental Care Only

Preventive & Diagnostic – You Only

$0

Preventive & Diagnostic – You and Your Family

$0

Cigna DPPO Dental Plan

Cigna DPPO – You Only

$8.52

Cigna DPPO – You and Your Family

$27.84

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 stipend.
  • 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

$0.026 per $1,000

Nicotine user

$0.028 per $1,000

25-29 Age Group

Non-nicotine user

$0.028 per $1,000

Nicotine user

$0.030 per $1,000

30-34 Age Group

Non-nicotine user

$0.035 per $1,000

Nicotine user

$0.038 per $1,000

35-39 Age Group

Non-nicotine user

$0.044 per $1,000

Nicotine user

$0.046 per $1,000

40-44 Age Group

Non-nicotine user

$0.057 per $1,000

Nicotine user

$0.063 per $1,000

45-49 Age Group

Non-nicotine user

$0.091 per $1,000

Nicotine user

$0.101 per $1,000

50-54 Age Group

Non-nicotine user

$0.146 per $1,000

Nicotine user

$0.162 per $1,000

55-59 AGE GROUP

Non-nicotine user

$0.249 per $1,000

Nicotine user

$0.277 per $1,000

60-64 AGE GROUP

Non-nicotine user

$0.354 per $1,000

Nicotine user

$0.393 per $1,000

65-69 AGE GROUP

Non-nicotine user

$0.598 per $1,000

Nicotine user

$0.664 per $1,000

70+ Age Group

Non-nicotine user

$0.939 per $1,000

Nicotine user

$1.043 per $1,000

Supplemental Life Insurance Premium Calculator

1. Enter your annual stipend

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

3. Select a Supplemental Life Option from 1 to 8

4. Your cost per bi-weekly 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 stipend.

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.