1.1 PY 2025 MEDICAL PLANS PREMIUM RATES_EXHIBIT A.PDF

Medical Benefits – Premium Rates – Exhibit A  
Plan Year 1/1/2025 to 12/31/2025  
Monthly Premium Rates 
 
 
Full-time Active Employees 
 Plan 
 Tier 
 Total Premium 
 Employer 
Premium  
 Employee 
Premium  
Cigna Network 
Employee 
     804.98  
     718.18  
         86.80  
Employee + Spouse 
   1,571.72  
   1,394.06  
       177.66  
Employee + Child(ren) 
   1,290.02  
   1,151.06  
       138.96  
Employee + Family 
   2,057.52  
   1,809.96  
       247.56  
UHC PPO 
Employee 
     842.86  
     729.14  
       113.72  
Employee + Spouse 
   1,648.58  
   1,387.60  
       260.98  
Employee + Child(ren) 
   1,352.58  
   1,138.06  
       214.52  
Employee + Family 
   2,159.14  
   1,791.86  
       367.28  
 
 
Cigna & UHC 
HDHP 
 
Employee 
     786.46  
     717.44  
         69.02  
Employee + Spouse 
   1,534.12  
   1,439.02  
         95.10  
Employee + Child(ren) 
   1,259.44  
   1,176.10  
         83.34  
Employee + Family 
   2,007.86  
   1,877.78  
       130.08  
 
  Part-Time Active Employees 
Plan 
 Tier 
  Total Premium 
Employer 
Premium 
 Employee 
Premium 
Cigna Network 
Employee 
     804.98  
     359.10  
       445.88  
Employee + Spouse 
   1,571.72  
     697.04  
       874.68  
Employee + Child(ren) 
   1,290.02  
     575.54  
       714.48  
Employee + Family 
   2,057.52  
     904.98  
     1,152.54  
UHC PPO 
Employee 
     842.86  
     364.58  
       478.28  
Employee + Spouse 
   1,648.58  
     693.80  
       954.78  
Employee + Child(ren) 
   1,352.58  
     569.04  
       783.54  
Employee + Family 
   2,159.14  
     895.92  
     1,263.22  
Cigna & UHC 
HDHP 
 
Employee 
     786.46  
     358.72  
       427.74  
Employee + Spouse 
   1,534.12  
     719.52  
       814.60  
Employee + Child(ren) 
   1,259.44  
     588.06  
       671.38  
Employee + Family 
   2,007.86  
     938.90  
     1,068.96