1.1 FY 2022-23 MEDICAL PLANS PREMIUM RATES_ EXHIBIT A.PDF

Medical Benefits – Premium Rates – Exhibit A 
FY 2022-23  
Based on 26 Pay Periods 
 
 
Full-time Active Employees 
 Plan 
 Tier 
 Pay Period Total 
Premium 
 Pay Period 
Employer 
Premium  
 Pay Period 
Employee 
Premium  
Cigna HMO 
Employee 
 371.53  
 331.46  
 40.07  
Employee + Spouse 
 725.41  
 643.40  
 82.01  
Employee + Child(ren) 
 595.39  
 531.24  
 64.15  
Employee + Family 
 949.62  
 835.36  
 114.26  
UHC PPO 
Employee 
 389.01  
 336.52  
 52.49  
Employee + Spouse 
 760.88  
 640.42  
 120.46  
Employee + Child(ren) 
 624.27  
 525.26  
 99.01  
Employee + Family 
 996.53  
 827.02  
 169.51  
Cigna & UHC 
HDHP 
Employee 
 362.98  
 331.12  
 31.86  
Employee + Spouse 
 708.06  
 664.16  
 43.90  
Employee + Child(ren) 
 581.28  
 542.82  
 38.46  
Employee + Family 
 926.70  
 866.66  
 60.04  
 
 
  Part-Time Active Employees 
Plan 
 Tier 
 Pay Period Total 
Premium 
Pay Period 
Employer 
Premium 
Pay Period 
Employee 
Premium 
Cigna HMO 
Employee 
       371.53  
      165.73  
        205.80  
Employee + Spouse 
       725.41  
      321.70  
        403.71  
Employee + Child(ren) 
       595.39  
      265.62  
        329.77  
Employee + Family 
       949.62  
      417.68  
        531.94  
UHC PPO 
Employee 
       389.01  
      168.26  
        220.75  
Employee + Spouse 
       760.88  
      320.21  
        440.67  
Employee + Child(ren) 
       624.27  
      262.63  
        361.64  
Employee + Family 
       996.53  
      413.51  
        583.02  
Cigna & UHC 
HDHP 
Employee 
       362.98  
      165.56  
        197.42  
Employee + Spouse 
       708.06  
      332.08  
        375.98  
Employee + Child(ren) 
       581.28  
      271.41  
        309.87  
Employee + Family 
       926.70  
      433.33  
        493.37