Plan Costs – Per Pay Period

Kaiser HMO

Employee Only: $40.65

Employee and Spouse/DP: $108.40

Employee and Child(ren): $108.40

Employee and Family: $162.60

Cigna $500 Gold PPO

Employee Only: $48.33

Employee and Spouse/DP: $128.06

Employee and Child(ren): $113.56

Employee and Family: $193.29

Cigna $250 Platinum PPO

Employee Only: $52.37

Employee and Spouse/DP: $138.77

Employee and Child(ren): $123.06

Employee and Family: $209.46

Guardian Dental Standard PPO

Employee Only: $2.45

Employee and Spouse/DP: $6.10

Employee and Child(ren): $7.49

Employee and Family: $11.14

Guardian Dental Premium PPO

Employee Only: $3.24

Employee and Spouse/DP: $8.06

Employee and Child(ren): $9.89

Employee and Family: $14.72

Guardian Vision

Employee Only: $0.62

Employee and Spouse/DP: $1.28

Employee and Child(ren): $1.31

Employee and Family: $2.30

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 Orca Bio if your domestic partner is your tax dependent.