Medical (bi-weekly cost) Employee Employee + Child(ren

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Medical (bi-weekly cost) Employee Employee + Child(ren
2016 Medtronic
U.S. Benefits Contributions
Medical (bi-weekly cost)
Consumer Health Plan (CHP)
Employee + Employee
Employee
Child(ren)
+ Spouse Family
$29.54
$56.31
$68.31
$95.08
$48.00
HealthPartners (MN only)
$97.38
$112.15 $146.31
The medical costs shown above assume:
BCBS Preferred Provider Organization (PPO)
Employee + Employee
Employee Child(ren)
+ Spouse Family
$55.38
$112.15
$125.54
$170.77
$47.54
Kaiser HMO (CA only)
$96.00
$103.85
$33.69
BCBS HRA (closed plan)
$75.69
$85.85
$129.69
$144.00
*You have completed the Healthier Together program requirements; otherwise your pre-tax deductions are
an additional $23.07/paycheck.
*You are not subject to the spouse surcharge; if your spouse has medical coverage available through their
employer (other than Medtronic) and is enrolled in your medical plan, you pay a surcharge of
$46.15/paycheck.
Dental (bi-weekly cost)
Comprehensive Plan
Employee + Employee
Employee
Child(ren)
+ Spouse Family
$6.92
$19.38
$13.38
$25.38
Vision (bi-weekly cost)
Employee
$5.52
Employee + Employee
Child(ren)
+ Spouse Family
$10.87
$9.18
$17.37
Basic Plan
Employee + Employee
Employee Child(ren)
+ Spouse Family
$5.54
$12.46
$9.69
$17.08
Long-Term Disability (LTD) Plan
Monthly rates are based on per $100 of coverage
LTD Buy-Up Options
Option 1: 60%
Option 2: 66 2/3%
LTD Examples (monthly cost)
Annual
Benefit Base Option 1: Option 2:
Rate
60%
66 2/3%
$25,000
$2.50
$3.13
$50,000
$5.00
$6.25
$75,000
$7.50
$9.38
$100,000
$10.00
$12.50
Rate
$0.12
$0.15
Optional Life Insurance
Employee
Monthly rates are based on
per $1,000 of coverage
Age
<25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Dependent Child(ren)
Coverage
Amount
$5,000
$10,000
$15,000
$20,000
$25,000
Rate
$0.016
$0.018
$0.025
$0.030
$0.033
$0.053
$0.076
$0.143
$0.219
$0.423
$0.689
Monthly
Cost
$0.50
$1.00
$1.50
$2.00
$2.50
Spouse
Coverage
Amount
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
$90,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
Monthly
Cost
$1.26
$2.52
$3.78
$5.04
$6.30
$7.56
$8.82
$10.08
$11.34
$12.60
$15.75
$18.90
$22.05
$25.20
$28.35
$31.50
AD&D Examples
Coverage
Coverage
Level
Amount
Employee
$100,000
Family
$500,000
Monthly
Cost
$1.70
$13.50
Accidental Death & Dismemberment (AD&D)
Monthly rates are based on per $1,000 of coverage
Coverage Level
Employee
Family
Rate
$0.017
$0.027

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