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Open Access
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Coverage LevelPer Payroll Amount OwedLeft Over Dollars Per Payroll-Amount Applied towards FSA/HASMonthly PremiumMonthly Employer ContributionAnnual PremiumAnnual Employer Contribution
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$6350 HSA
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Employee Only $ - $ 106.88 $ 562.90 $ 776.67 $ 6,754.80 $ 9,320.00
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EE+1 $ 156.45 $ - $ 1,181.23 $ 868.33 $ 14,174.76 $ 10,420.00
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Family $ 404.68 $ - $ 1,827.69 $ 1,018.33 $ 21,932.28 $ 12,220.00
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$1500 HSA
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Employee Only $ - $ 51.39 $ 673.89 $ 776.67 $ 8,086.68 $ 9,320.00
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EE+1 $ 272.90 $ - $ 1,414.14 $ 868.33 $ 16,969.68 $ 10,420.00
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Family $ 584.86 $ - $ 2,188.06 $ 1,018.33 $ 26,256.72 $ 12,220.00
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$1750
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Employee Only $ 1.73 $ - $ 780.13 $ 776.67 $ 9,361.56 $ 9,320.00
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EE+1 $ 384.37 $ - $ 1,637.08 $ 868.33 $ 19,644.96 $ 10,420.00
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Family $ 757.34 $ - $ 2,533.02 $ 1,018.33 $ 30,396.24 $ 12,220.00
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* Rates do not include dental costs.
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