Plan Costs (Semi-Monthly)
Blue Shield HSA Compatible PPO – CA and OOS
Employee Only (CA): $0.00
Employee Only (OOS): $0.00
Employee and Spouse (CA): $222.46
Employee and Spouse (OOS): $199.96
Employee and Child(ren) (CA): $119.79
Employee and Child(ren): (OOS): $107.68
Employee and Family: (CA): $325.13
Employee and Family: (OOS): $292.24
Blue Shield PPO 80/60 – CA and OOS
Employee Only (CA): $0.00
Employee Only (OOS): $0.00
Employee and Spouse (CA): $293.61
Employee and Spouse (OOS): $265.24
Employee and Child(ren) (CA): $158.10
Employee and Child(ren) (OOS): $142.82
Employee and Family (CA): $429.14
Employee and Family (OOS): $387.63
Blue Shield PPO 90/70 – CA and OOS
Employee Only (CA): $55.44
Employee Only (OOS): $51.06
Employee and Spouse (CA): $421.12
Employee and Spouse (OOS): $382.66
Employee and Child(ren) (CA): $252.34
Employee and Child(ren) (OOS): $229.61
Employee and Family: (CA): $589.87
Employee and Family: (OOS): $535.73
Kaiser HMO (CA Only)
Employee Only: $0.00
Employee and Spouse: $338.37
Employee and Child(ren): $335.14
Employee and Family: $477.49
MetLife Dental PPO Plan
Employee Only: $0.00
Employee and Spouse: $14.05
Employee and Child(ren): $12.62
Employee and Family: $29.01
MetLife Vision Plan
Employee Only: $0.00
Employee + One Dependent: $0.63
Employee + 2 or more Dependents: $2.01
Plan Costs (Monthly)
Blue Shield HSA Compatible PPO – CA and OOS
Employee Only (CA): $0.00
Employee Only (OOS): $0.00
Employee and Spouse (CA): $444.91
Employee and Spouse (OOS): $399.91
Employee and Child(ren) (CA): $239.58
Employee and Child(ren) (OOS): $215.35
Employee and Family (CA): $650.26
Employee and Family (OOS): $584.47
Blue Shield PPO 80/60 – CA and OOS
Employee Only (CA): $0.00
Employee Only (OOS): $0.00
Employee and Spouse (CA): $587.21
Employee and Spouse (OOS): $530.47
Employee and Child(ren) (CA): $316.20
Employee and Child(ren) (OOS): $285.64
Employee and Family (CA): $858.28
Employee and Family (OOS): $775.26
Blue Shield PPO 90/70 – CA and OOS
Employee Only (CA): $110.87
Employee Only (OOS): $102.11
Employee and Spouse (CA): $842.23
Employee and Spouse (OOS): $765.31
Employee and Child(ren) (CA): $504.68
Employee and Child(ren) (OOS): $459.22
Employee and Family (CA): $1,1179.74
Employee and Family (OOS): $1,71.45
Kaiser HMO (CA Only)
Employee Only: $0.00
Employee and Spouse: $676.75
Employee and Child(ren): $670.28
Employee and Family: $954.98
MetLife Dental PPO Plan
Employee Only: $0.00
Employee and Spouse: $28.09
Employee and Child(ren): $25.24
Employee and Family: $58.01
MetLife Vision Plan
Employee Only: $0.00
Employee + One Dependent: $1.25
Employee + 2 or more Dependents: $4.02
Domestic Partner Coverage
Please note that unless your domestic partner is your tax dependent as defined by the IRS, contributions for domestic partner coverage must be made after-tax. Similarly, the company contribution toward coverage for your domestic partner and his/her dependents will be reported as taxable income on your W-2. Contact your tax advisor for more details on how this tax treatment applies to you. Notify iD Tech if your domestic partner is your tax dependent.