LOA Other Than Family and Medical Leave - Premium for Continuation of Benefits

Effective January 1, 2018

Biweekly premiums for each insurance provider, by coverage plan:

Provider

Employee

Employee and Spouse

Employee and Children

Family: Employee, Spouse, Child(ren)

Empire Blue Cross Traditional PPO

$408.05

$854.83

$721.44

$1,220.97

Empire Blue Cross Deductible PPO

$375.23

$789.17

$662.35

$1,122.50

Blue Choice (BCBS of Rochester/Excellus)

$318.62

$732.64

$802.25

$844.55

Capital District Physicians Health Plan (CDPHP - All areas)

$339.96

$679.93

$645.93

$951.90

Independent Health Association (IHA)

$309.93

$743.83

$557.88

$867.81

MVP Health Plan

$408.77

$940.36

$775.75

$1,067.10

Dental

$15.94

$37.68

$37.68

$37.68

Vision

$1.71

$4.07

$4.07

$4.07

Basic Life Insurance

Biweekly premium that equals the amount of coverage X $.044 per thousand ($2.20 biweekly for $50,000 of coverage)

Note: Claims made while in active, eligible status will count toward policy deductibles and limitations during the continuation period.

Additional information and an application for continuation of group coverage while on Leave of Absence other than FMLA leave is available on the Policies section of RF Web site under Leave Administration.

Change History

 

 

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