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): $206.93
Employee and Spouse (OOS): $186.01
Employee and Child(ren) (CA): $111.43
Employee and Child(ren): (OOS): $100.17
Employee and Family: (CA): $302.45
Employee and Family: (OOS): $271.86
Blue Shield PPO 80/60 – CA and OOS
Employee Only (CA): $0.00
Employee Only (OOS): $0.00
Employee and Spouse (CA): $273.12
Employee and Spouse (OOS): $246.73
Employee and Child(ren) (CA): $147.07
Employee and Child(ren) (OOS): $132.86
Employee and Family (CA): $399.20
Employee and Family (OOS): $360.59
Blue Shield PPO 90/70 – CA and OOS
Employee Only (CA): $51.58
Employee Only (OOS): $47.50
Employee and Spouse (CA): $391.73
Employee and Spouse (OOS): $355.97
Employee and Child(ren) (CA): $234.75
Employee and Child(ren) (OOS): $213.59
Employee and Family: (CA): $548.71
Employee and Family: (OOS): $498.35
Kaiser HMO (CA Only)
Employee Only: $0.00
Employee and Spouse: $304.57
Employee and Child(ren): $301.66
Employee and Family: $429.79
MetLife Dental PPO Plan
Employee Only: $0.00
Employee and Spouse: $13.01
Employee and Child(ren): $11.69
Employee and Family: $26.86
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): $413.86
Employee and Spouse (OOS): $372.02
Employee and Child(ren) (CA): $222.86
Employee and Child(ren) (OOS): $200.33
Employee and Family (CA): $604.89
Employee and Family (OOS): $543.71
Blue Shield PPO 80/60 – CA and OOS
Employee Only (CA): $0.00
Employee Only (OOS): $0.00
Employee and Spouse (CA): $546.24
Employee and Spouse (OOS): $493.46
Employee and Child(ren) (CA): $294.13
Employee and Child(ren) (OOS): $265.71
Employee and Family (CA): $798.39
Employee and Family (OOS): $721.17
Blue Shield PPO 90/70 – CA and OOS
Employee Only (CA): $103.15
Employee Only (OOS): $95.00
Employee and Spouse (CA): $783.46
Employee and Spouse (OOS): $711.93
Employee and Child(ren) (CA): $469.49
Employee and Child(ren) (OOS): $427.18
Employee and Family (CA): $1,097.42
Employee and Family (OOS): $996.70
Kaiser HMO (CA Only)
Employee Only: $0.00
Employee and Spouse: $609.13
Employee and Child(ren): $603.32
Employee and Family: $859.57
MetLife Dental PPO Plan
Employee Only: $0.00
Employee and Spouse: $26.01
Employee and Child(ren): $23.37
Employee and Family: $53.71
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.