Cost Summary
Explanation of Benefits
Health Care Summary EOB
Beyond Health Care Summary EOB
Coverage Plan |
Employee Contribution |
City Contribution |
Total Monthly Cost |
---|---|---|---|
Employee Only | $26 | $489 | $515 |
Employee + Child | $264 | $561 | $825 |
Employee + Children | $379 | $806 | $1,185 |
Employee + Spouse | $330 | $701 | $1,031 |
Family | $544 | $1,156 | $1,700 |
Family (both employees)** | $153 | $1,547 | $1,700 |
**This coverage tier is only available to eligible employees enrolled prior to January 1, 2016.
Vision Plan |
City Contribution per month |
Employee Contribution per month |
---|---|---|
Employee Only |
$3.91 | $0 |
Employee + Dependent (spouse or one child) |
$4.16 | $3.67 effective 1/1/2022 |
Family |
$4.24 | $7.50 effective 1/1/2022 |
Prescription Coverage |
City Cost |
Employee Cost |
---|---|---|
Administered by Anthem Blue Cross |
60% for 30-day supply | 40% for 30-day supply |
Dental Plan |
City Contribution per month |
Employee Contribution per month |
---|---|---|
Employee Only | $28 | $0 |
Employee + Dependent (spouse or one child) |
$28 | $22 |
Family | $28 | $39 |
Retirement |
City Contribution |
Employee Contribution |
---|---|---|
Virginia Retirement System (VRS) |
The City pays employer portion (20.96%) of base pay towards the retirement and disability benefit | Employees pay the 5% member portion of this benefit |
457 Deferred Compensation (MissionSquare, formerly ICMA) |
N/A |
2022: Max. up to $20,500 annually or $27,000 if age 50+ 2023: Max. up to $22,500 annually or $30,000 if age 50+ |
Roth IRA (MissionSquare, formerly ICMA) |
N/A |
2022: Max. up to $6,000 annually or $7,000 if age 50+ 2023: Max. up to $6,500 annually or $7,500 if age 50+ |
Group Life Insurance |
City Contribution |
---|---|
Group Life Insurance 2x annual pay - natural death 4x annual pay - accidental death |
1.34% of pay |
Optional Life Insurance Coverage
How to calculate monthly cost of optional life insurance:
1. Decide how much additional life insurance you want for yourself. Choose Option 1, 2, 3, or 4 and whether you want coverage on spouse and children.
2. Find cost per $1,000 of coverage next to your age in Employee + Spouse Rates table below.
3. Multiply cost times per $1,000 of life insurance coverage. For example, if one times your annual base pay is $20,000, and your age is 35, you would multiply 20 times .06 to find a monthly cost of $1.20.
4. Based on option chosen and corresponding spouse coverage, if any, repeat formula using cost based on spouse's age for spouse premium.
5. Children's premium is a flat rate based on the option you choose. See rates below.
Optional Life Coverage |
Employee |
Spouse |
Children |
---|---|---|---|
Option | Insurance Amount | Insurance Amount | Insurance Amount |
1 | 1x Annual Base Pay | .5 Employee Base Pay | $10,000 |
2 | 2x Annual Base Pay | 1x Employee Base Pay | $10,000 |
3 | 3x Annual Base Pay | 1.5x Employee Base Pay | $20,000 |
4 | 4x Annual Base Pay | 2x Employee Base Pay | $30,000 |
Optional Life Rates |
Employee + Spouse |
---|---|
Age | Monthly Rates Per $1000 |
Under 30 | $0.05 |
30 - 34 | $0.05 |
35 - 39 | $0.06 |
40 - 44 | $0.08 |
45 - 49 | $0.14 |
50 - 54 | $0.20 |
55 - 59 | $0.33 |
60 - 64 | $0.59 |
65 - 69 | $1.06 |
70 and over | $2.06 |
Optional Life Rates |
Children |
|
---|---|---|
Option | Insurance Amount | Flat Monthly Rate |
1 | $10,000 | $0.80 |
2 | $10,000 | $0.80 |
3 | $20,000 | $1.60 |
4 | $30,000 | $2.40 |
Cost of Maintaining Coverage When Employment Ends
Medical Coverage |
Monthly COBRA Rate |
---|---|
Individual Only | $525 |
Individual + Spouse | $1,052 |
Individual + Child | $842 |
Individual + Children | $1,209 |
Family | $1,734 |
Family - Two Married City Employees | $1,734 |
Dental Coverage |
Monthly COBRA Rate |
---|---|
Individual Only | $29 |
Individual + One | $51 |
Family | $68 |
Vision Coverage |
Monthly COBRA Rate |
---|---|
Individual Only | $3.91 |
Individual + One | $7.83 |
Family | $11.74 |
You will receive information in the mail from HR about COBRA.
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