Note: Provided below is guidance intended for State departmental and program use only. To view more guidance and policy information, please visit the Central Payroll Services page.
Glossary of Terms
- CPPS: Central Payroll Processing System
- GTN: Gross-to-net
- Empl: Employee
- HDHP: High Deductible Health Plan
- NTD: Non-taxable dependent
- AD&D: Accidental Death & Dismemberment
- STD: Short-term disability
- LTD: Long-term disability
FY2025 - State Of Colorado Monthly Rates / CPPS GTNs and Option Codes
Cigna HDHP
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Employee Share | 201 | 202 | $31.10 | $168.38 | $66.66 | $266.88 |
| State Contribution | No Value | 203 | $849.26 | $1,523.60 | $1,485.90 | $2,095.54 |
| Total Rate | No Value | No Value | $880.36 | $1,691.98 | $1,552.56 | $2,362.42 |
Cigna Copay Plus
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Employee Share | 210 | 211 | $99.30 | $307.44 | $171.52 | $465.06 |
| State Contribution | No Value | 212 | $808.86 | $1,501.70 | $1,482.84 | $2,088.32 |
| Total Rate | No Value | No Value | $908.16 | $1,809.14 | $1,654.36 | $2,553.38 |
Cigna Copay Basic
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Employee Share | 213 | 214 | $43.44 | $204.04 | $77.60 | $286.34 |
| State Contribution | No Value | 215 | $828.94 | $1,532.90 | $1,510.82 | $2,164.76 |
| Total Rate | No Value | No Value | $872.38 | $1,736.94 | $1,588.42 | $2,451.10 |
Kaiser HDHP
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Employee Share | 216 | 217 | $32.32 | $177.40 | $62.48 | $224.04 |
| State Contribution | No Value | 218 | $699.86 | $1,269.00 | $1,254.54 | $1,807.12 |
| Total Rate | No Value | No Value | $732.18 | $1,446.40 | $1,317.02 | $2,031.16 |
Kaiser Copay Plus
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Employee Share | 219 | 220 | $64.40 | $275.56 | $134.76 | $437.52 |
| State Contribution | No Value | 221 | $748.82 | $1,405.08 | $1,387.76 | $1,953.82 |
| Total Rate | No Value | No Value | $813.22 | $1,680.64 | $1,522.52 | $2,391.34 |
Kaiser Copay Basic
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Employee Share | 222 | 223 | $42.82 | $196.06 | $79.12 | $320.92 |
| State Contribution | No Value | 224 | $727.86 | $1,395.36 | $1,362.68 | $1,942.96 |
| Total Rate | No Value | No Value | $770.68 | $1,591.42 | $1,441.80 | $2,263.88 |
Eyemed Vision - Basic
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (TV1/PV1) | Empl + Spouse (TV2/PV2) | Empl + Child(ren) (TV3/PV3) | Empl + Spouse + Child(ren) (TV4/PV4) |
|---|
| Employee Share | 228 | 229 | $0.00 | $0.00 | $0.00 | $0.00 |
| State Contribution | No Value | 230 | $3.18 | $6.06 | $6.38 | $9.38 |
| Total Rate | No Value | No Value | $3.18 | $6.06 | $6.38 | $9.38 |
Eyemed Vision - Enhanced
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (TE1/PE1) | Empl + Spouse (TE2/PE2) | Empl + Child(ren) (TE3/PE3) | Empl + Spouse + Child(ren) (TE4/PE4) |
|---|
| Employee Share | 228 | 229 | $4.40 | $8.36 | $8.80 | $12.92 |
| State Contribution | No Value | 230 | $3.18 | $6.06 | $6.38 | $9.38 |
| Total Rate | No Value | No Value | $7.58 | $14.42 | $15.18 | $22.30 |
Delta Dental - Basic
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1A/P1A) | Empl + Spouse (T2A/P2A) | Empl + Child(ren) (T3A/P3A) | Empl + Spouse + Child(ren) (T4A/P4A) |
|---|
| Employee Share | 237 | 238 | $4.66 | $17.12 | $16.02 | $29.42 |
| State Contribution | No Value | 239 | $33.96 | $55.38 | $60.06 | $80.54 |
| Total Rate | No Value | No Value | $38.62 | $72.50 | $76.08 | $109.96 |
Delta Dental - Basic Plus
| Contribution Type | Gtn (After-Tax) | Gtn (Pre-Tax) | Empl Only (T1B/P1B) | Empl + Spouse (T2B/P2B) | Empl + Child(ren) (T3B/P3B) | Empl + Spouse + Child(ren) (T4B/P4B) |
|---|
| Employee Share | 237 | 238 | $10.74 | $29.26 | $28.72 | $48.20 |
| State Contribution | No Value | 239 | $36.96 | $60.94 | $65.96 | $89.00 |
| Total Rate | No Value | No Value | $47.70 | $90.20 | $94.68 | $137.20 |
Other Benefits Information
- Basic Life: GTN 244 - $8.88
- Employee Optional Life: GTN 241
- Spouse Optional Life: GTN 242
- Dependent Optional Life: GTN 243
- STD: GTN 246
- 0.15% of eligible gross pay
- LTD: GTN 245
- Flexible Spending Accounts:
- Health: GTN 247 (After-tax 249) Limit 3200.00
- Dependent: GTN 248 (After-tax 236) Limit 5000.00
- Ltd. Purpose: GTN 251 - Limit 3200.00
FY2025 - Imputed Income Rates for Civil Unions
Cigna HDHP
| Contribution Type | GTN & Tax Election | EE + C. Union (T2/P2) | EE + C. Union's Child(ren) (T3/P3) | EE + C. Union + EE's Child(ren) (T4/P4) | EE + C. Union + C. Union's Child(ren) (T4/P4) |
|---|
| NTD Amount | 201: After-Tax | $674.34 | $636.64 | $674.34 | $1,246.28 |
| NTD Amount | 202: Pre-Tax | $811.62 | $672.20 | $811.62 | $1,482.06 |
Cigna Copay Plus
| Contribution Type | GTN & Tax Election | EE + C. Union (T2/P2) | EE + C. Union's Child(ren) (T3/P3) | EE + C. Union + EE's Child(ren) (T4/P4) | EE + C. Union + C. Union's Child(ren) (T4/P4) |
|---|
| NTD Amount | 210: After-Tax | $692.84 | $673.98 | $692.84 | $1,279.46 |
| NTD Amount | 2211: Pre-Tax | $900.98 | $746.20 | $900.98 | $1,645.22 |
Cigna Copay Basic
| Contribution Type | GTN & Tax Election | EE + C. Union (T2/P2) | EE + C. Union's Child(ren) (T3/P3) | EE + C. Union + EE's Child(ren) (T4/P4) | EE + C. Union + C. Union's Child(ren) (T4/P4) |
|---|
| NTD Amount | 213: After-Tax | $703.96 | $681.88 | $703.96 | $1,335.82 |
| NTD Amount | 214: Pre-Tax | $864.56 | $716.04 | $864.56 | $1,578.72 |
Kaiser HDHP
| Contribution Type | GTN & Tax Election | EE + C. Union (T2/P2) | EE + C. Union's Child(ren) (T3/P3) | EE + C. Union + EE's Child(ren) (T4/P4) | EE + C. Union + C. Union's Child(ren) (T4/P4) |
|---|
| NTD Amount | 216: After-Tax | $569.14 | $554.68 | $569.14 | $1,107.26 |
| NTD Amount | 217: Pre-Tax | $714.22 | $584.84 | $714.22 | $1,298.98 |
Kaiser Copay Plus
| Contribution Type | GTN & Tax Election | EE + C. Union (T2/P2) | EE + C. Union's Child(ren) (T3/P3) | EE + C. Union + EE's Child(ren) (T4/P4) | EE + C. Union + C. Union's Child(ren) (T4/P4) |
|---|
| NTD Amount | 219: After-Tax | $656.26 | $638.94 | $656.26 | $1,205.00 |
| NTD Amount | 220: Pre-Tax | $867.42 | $709.30 | $867.42 | $1,578.12 |
Kaiser Copay Basic
| Contribution Type | GTN & Tax Election | EE + C. Union (T2/P2) | EE + C. Union's Child(ren) (T3/P3) | EE + C. Union + EE's Child(ren) (T4/P4) | EE + C. Union + C. Union's Child(ren) (T4/P4) |
|---|
| NTD Amount | 222: After-Tax | $667.50 | $634.82 | $667.50 | $1,215.10 |
| NTD Amount | 223: Pre-Tax | $820.74 | $671.12 | $820.74 | $1,493.20 |
EyeMed Vision - Basic
| Contribution Type | GTN & Tax Election | EE + C. Union (T2A/P2A) | EE + C. Union's Child(ren) (T3A/P3A) | EE + C. Union + EE's Child(ren) (T4A/P4A) | EE + C. Union + C. Union's Child(ren) (T4A/P4A) |
|---|
| NTD Amount | 237: After-Tax | $2.88 | $3.20 | $2.88 | $6.20 |
| NTD Amount | 238: Pre-Tax | $2.88 | $3.20 | $2.88 | $6.20 |
EyeMed Vision - Enhanced
| Contribution Type | GTN & Tax Election | EE + C. Union (T2B/P2B) | EE + C. Union's Child(ren) (T3B/P3B) | EE + C. Union + EE's Child(ren) (T4B/P4B) | EE + C. Union + C. Union's Child(ren) (T4B/T4P) |
|---|
| NTD Amount | 237: After-Tax | $2.88 | $3.20 | $2.88 | $6.20 |
| NTD Amount | 238: Pre-Tax | $6.84 | $7.60 | $6.84 | $14.72 |
Delta Dental - Basic
| Contribution Type | GTN & Tax Election | EE + C. Union (T2A/P2A) | EE + C. Union's Child(ren) (T3A/P3A) | EE + C. Union + EE's Child(ren) (T4A/P4A) | EE + C. Union + C. Union's Child(ren) (T4A/P4A) |
|---|
| NTD Amount | 237: After-Tax | $12.46 | $11.36 | $12.46 | $24.76 |
| NTD Amount | 238: Pre-Tax | $21.42 | $26.10 | $21.42 | $46.58 |
Delta Dental - Basic Plus
| Contribution Type | GTN & Tax Election | Empl Only (T1B/P1B) | Empl + Spouse (T2B/P2B) | Empl + Child(ren) (T3B/P3B) | Empl + Spouse + Child(ren) (T4B/T4B) |
|---|
| NTD Amount | 237: After-Tax | $10.74 | $29.26 | $28.72 | $48.20 |
| NTD Amount | 238: Pre-Tax | $36.96 | $60.94 | $65.96 | $89.00 |
For after-tax elections, the taxable amount is the difference of the state shares. For pre-tax elections, the taxable amount is the difference of the total rates. The NTD amount for employees with pre-tax deductions is higher because the employee should not receive a tax benefit for covering a non-tax dependent. The higher NTD amount removes the tax benefit the employee derives from their pre-tax payroll deduction.
The NTD amount should only be entered for the plan(s) that the non-tax dependent has coverage for (ex: do not enter NTD for dental if the non-tax dependent only has medical). If the non-tax dependent has coverage for both medical and dental plans, then the amounts should be added together.
FY2025 - Health and Wellness Rates
Wellness Program Participation: Employees who participate in the wellness program are eligible to receive a $20/month premium reduction.
Cigna HDHP
| Contribution Type | GTN (After-Tax) | GTN (Pre-Tax) | Empl Only (TW1/PW1) | Empl + Spouse (TW2/PW2) | Empl + Child(ren) (TW3/PW3) | Empl + Spouse + Child(ren) (TW4/PW4) |
|---|
| Employee Share | 201 | 202 | $11.10 | $148.38 | $46.66 | $246.88 |
| State Contribution | 203 | No Value | $849.26 | $1,523.60 | $1,485.90 | $2,095.54 |
Cigna Copay Plus
| Contribution Type | GTN (After-Tax) | GTN (Pre-Tax) | Empl Only (TW1/PW1) | Empl + Spouse (TW2/PW2) | Empl + Child(ren) (TW3/PW3) | Empl + Spouse + Child(ren) (TW4/PW4) |
|---|
| Employee Share | 210 | 211 | $79.30 | $287.44 | $151.52 | $445.06 |
| State Contribution | 212 | No Value | $808.86 | $1,501.70 | $1,482.84 | $2,088.32 |
Cigna Copay Basic
| Contribution Type | GTN (After-Tax) | GTN (Pre-Tax) | Empl Only (TW1/PW1) | Empl + Spouse (TW2/PW2) | Empl + Child(ren) (TW3/PW3) | Empl + Spouse + Child(ren) (TW4/PW4) |
|---|
| Employee Share | 213 | 214 | $23.44 | $184.04 | $57.60 | $266.34 |
| State Contribution | 215 | No Value | $828.94 | $1,532.90 | $1,510.82 | $2,164.76 |
Kaiser HDHP
| Contribution Type | GTN (After-Tax) | GTN (Pre-Tax) | Empl Only (TW1/PW1) | Empl + Spouse (TW2/PW2) | Empl + Child(ren) (TW3/PW3) | Empl + Spouse + Child(ren) (TW4/PW4) |
|---|
| Employee Share | 216 | 217 | $12.32 | $157.40 | $42.48 | $204.04 |
| State Contribution | 218 | No Value | $699.86 | $1,269.00 | $1,254.54 | $1,807.12 |
Kaiser Copay Plus
| Contribution Type | GTN (After-Tax) | GTN (Pre-Tax) | Empl Only (TW1/PW1) | Empl + Spouse (TW2/PW2) | Empl + Child(ren) (TW3/PW3) | Empl + Spouse + Child(ren) (TW4/PW4) |
|---|
| Employee Share | 219 | 220 | $44.40 | $255.56 | $114.76 | $417.52 |
| State Contribution | 221 | No Value | $748.82 | $1,405.08 | $1,387.76 | $1,953.82 |
Kaiser Copay Basic
| Contribution Type | GTN (After-Tax) | GTN (Pre-Tax) | Empl Only (TW1/PW1) | Empl + Spouse (TW2/PW2) | Empl + Child(ren) (TW3/PW3) | Empl + Spouse + Child(ren) (TW4/PW4) |
|---|
| Employee Share | 222 | 223 | $22.82 | $176.06 | $59.12 | $300.92 |
| State Contribution | 224 | No Value | $727.86 | $1,395.36 | $1,362.68 | $1,942.96 |
FY2025 - Subsidy Rates (Group A)
Cigna HDHP
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T3T/P3T) | Empl + Spouse + Child(ren) (T4T/P4T) |
|---|
| Employee Share | 201 | 202 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $66.66 | $266.88 |
| State Contribution | 203 | No Value | $1,485.90 | $2,095.54 |
| Total Rate | No Value | No Value | $1,552.56 | $2,362.42 |
Cigna Copay Plus
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T3T/P3T) | Empl + Spouse + Child(ren) (T4T/P4T) |
|---|
| Employee Share | 210 | 211 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $171.52 | $465.06 |
| State Contribution | 212 | No Value | $1,482.84 | $2,088.32 |
| Total Rate | No Value | No Value | $1,654.36 | $2,553.38 |
Cigna Copay Basic
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T3T/P3T) | Empl + Spouse + Child(ren) (T4T/P4T) |
|---|
| Employee Share | 213 | 214 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $77.60 | $286.34 |
| State Contribution | 215 | No Value | $1,510.82 | $2,164.76 |
| Total Rate | No Value | No Value | $1,588.42 | $2,451.10 |
Kaiser HDHP
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T3T/P3T) | Empl + Spouse + Child(ren) (T4T/P4T) |
|---|
| Employee Share | 216 | 217 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $62.48 | $224.04 |
| State Contribution | 218 | No Value | $1,254.54 | $1,807.12 |
| Total Rate | No Value | No Value | $1,317.02 | $2,031.16 |
Kaiser Copay Plus
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T3T/P3T) | Empl + Spouse + Child(ren) (T4T/P4T) |
|---|
| Employee Share | 219 | 220 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $134.76 | $437.52 |
| State Contribution | 221 | No Value | $1,387.76 | $1,953.82 |
| Total Rate | No Value | No Value | $1,522.52 | $2,391.34 |
Kaiser Copay Basic
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T3T/P3T) | Empl + Spouse + Child(ren) (T4T/P4T) |
|---|
| Employee Share | 222 | 223 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $79.12 | $320.92 |
| State Contribution | 224 | No Value | $1,362.68 | $1,942.96 |
| Total Rate | No Value | No Value | $1,441.80 | $2,263.88 |
Delta Dental - Basic
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T5A/P5A) | Empl + Spouse + Child(ren) (T6A/P6A) |
|---|
| Employee Share | 237 | 238 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $16.02 | $29.42 |
| State Contribution | 239 | No Value | $60.06 | $80.54 |
| Total Rate | No Value | No Value | $76.08 | $109.96 |
Delta Dental - Basic Plus
| Category | GTN (After-Tax) | GTN (Pre-Tax) | Empl + Child(ren) (T5B/P5B) | Empl + Spouse + Child(ren) (T6B/P6B) |
|---|
| Employee Share | 237 | 238 | No Value | No Value |
| Subsidy Amount | No Value | No Value | $28.72 | $48.20 |
| State Contribution | 239 | No Value | $65.96 | $89.00 |
| Total Rate | No Value | No Value | $94.68 | $137.20 |
FY2025 - COBRA Rates
Cigna HDHP
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $17.61 | $33.84 | $31.05 | $47.25 |
| Premium | $880.36 | $1,691.98 | $1,552.56 | $2,362.42 |
| Total Rate | $897.97 | $1,725.82 | $1,583.61 | $2,409.67 |
Cigna Copay Plus
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $18.16 | $36.18 | $33.09 | $51.07 |
| Premium | $908.16 | $1,809.14 | $1,654.36 | $2,553.38 |
| Total Rate | $926.32 | $1,845.32 | $1,687.45 | $2,604.45 |
Cigna Copay Basic
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $17.45 | $34.74 | $31.77 | $49.02 |
| Premium | $872.38 | $1,736.94 | $1,588.42 | $2,451.10 |
| Total Rate | $889.83 | $1,771.68 | $1,620.19 | $2,500.12 |
Kaiser HDHP
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $14.64 | $28.93 | $26.34 | $40.62 |
| Premium | $732.18 | $1,446.40 | $1,317.02 | $2,031.16 |
| Total Rate | $746.82 | $1,475.33 | $1,343.36 | $2,071.78 |
Kaiser Copay Plus
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $16.26 | $33.61 | $30.45 | $47.83 |
| Premium | $813.22 | $1,680.64 | $1,522.52 | $2,391.34 |
| Total Rate | $829.48 | $1,714.25 | $1,552.97 | $2,439.17 |
Kaiser Copay Basic
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $15.41 | $31.83 | $28.84 | $45.28 |
| Premium | $770.68 | $1,591.42 | $1,441.80 | $2,263.88 |
| Total Rate | $786.09 | $1,623.25 | $1,470.64 | $2,309.16 |
Eyemed Vision - Basic
| Cost Component | Empl Only (TV1/PV1) | Empl + Spouse (TV2/PV2) | Empl + Child(ren) (TV3/PV3) | Empl + Spouse + Child(ren) (TV4/PV4) |
|---|
| Administrative Cost | $0.06 | $0.12 | $0.13 | $0.19 |
| Premium | $3.18 | $6.06 | $6.38 | $9.38 |
| Total Rate | $3.24 | $6.18 | $6.51 | $9.57 |
Eyemed Vision - Enhanced
| Cost Component | Empl Only (TE1/PE1) | Empl + Spouse (TE2/PE2) | Empl + Child(ren) (TE3/PE3) | Empl + Spouse + Child(ren) (TE4/PE4) |
|---|
| Administrative Cost | $0.15 | $0.29 | $0.30 | $0.45 |
| Premium | $7.58 | $14.42 | $15.18 | $22.30 |
| Total Rate | $7.73 | $14.71 | $15.48 | $22.75 |
Delta Dental - Basic
| Cost Component | Empl Only (T1A/P1A) | Empl + Spouse (T2A/P2A) | Empl + Child(ren) (T3A/P3A) | Empl + Spouse + Child(ren) (T4A/P4A) |
|---|
| Administrative Cost | $0.77 | $1.45 | $1.52 | $2.20 |
| Premium | $38.62 | $72.50 | $76.08 | $109.96 |
| Total Rate | $39.39 | $73.95 | $77.60 | $112.16 |
Delta Dental - Basic Plus
| Cost Component | Empl Only (T1B/P1B) | Empl + Spouse (T2B/P2B) | Empl + Child(ren) (T3B/P3B) | Empl + Spouse + Child(ren) (T4B/P4B) |
|---|
| Administrative Cost | $0.95 | $1.80 | $1.89 | $2.74 |
| Premium | $47.70 | $90.20 | $94.68 | $137.20 |
| Total Rate | $48.65 | $92.00 | $96.57 | $139.94 |
FY2025 - COBRA Rates w/ Disability Extension
Cigna HDHP
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $440.18 | $845.99 | $776.28 | $1,181.21 |
| Premium | $880.36 | $1,691.98 | $1,552.56 | $2,362.42 |
| Total Rate | $1,320.54 | $2,537.97 | $2,328.84 | $3,543.63 |
Cigna Copay Plus
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $454.08 | $904.57 | $827.18 | $1,276.69 |
| Premium | $908.16 | $1,809.14 | $1,654.36 | $2,553.38 |
| Total Rate | $1,362.24 | $2,713.71 | $2,481.54 | $3,830.07 |
Cigna Copay Basic
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $436.19 | $868.47 | $794.21 | $1,225.55 |
| Premium | $872.38 | $1,736.94 | $1,588.42 | $2,451.10 |
| Total Rate | $1,308.57 | $2,605.41 | $2,382.63 | $3,676.65 |
Kaiser HDHP
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $366.09 | $723.20 | $658.51 | $1,015.58 |
| Premium | $732.18 | $1,446.40 | $1,317.02 | $2,031.16 |
| Total Rate | $1,098.27 | $2,169.60 | $1,975.53 | $3,046.74 |
Kaiser Copay Plus
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $406.61 | $840.32 | $761.26 | $1,195.67 |
| Premium | $813.22 | $1,680.64 | $1,522.52 | $2,391.34 |
| Total Rate | $1,219.83 | $2,520.96 | $2,283.78 | $3,587.01 |
Kaiser Copay Basic
| Cost Component | Empl Only (T1/P1) | Empl + Spouse (T2/P2) | Empl + Child(ren) (T3/P3) | Empl + Spouse + Child(ren) (T4/P4) |
|---|
| Administrative Cost | $385.34 | $795.71 | $720.90 | $1,131.94 |
| Premium | $770.68 | $1,591.42 | $1,441.80 | $2,263.88 |
| Total Rate | $1,156.02 | $2,387.13 | $2,162.70 | $3,395.82 |
Eyemed Vision - Basic
| Cost Component | Empl Only (TV1/PV1) | Empl + Spouse (TV2/PV2) | Empl + Child(ren) (TV3/PV3) | Empl + Spouse + Child(ren) (TV4/PV4) |
|---|
| Administrative Cost | $1.59 | $3.03 | $3.19 | $4.69 |
| Premium | $3.18 | $6.06 | $6.38 | $9.38 |
| Total Rate | $4.77 | $9.09 | $9.57 | $14.07 |
Eyemed Vision - Enhanced
| Cost Component | Empl Only (TE1/PE1) | Empl + Spouse (TE2/PE2) | Empl + Child(ren) (TE3/PE3) | Empl + Spouse + Child(ren) (TE4/PE4) |
|---|
| Administrative Cost | $3.79 | $7.21 | $7.59 | $11.15 |
| Premium | $7.58 | $14.42 | $15.18 | $22.30 |
| Total Rate | $11.37 | $21.63 | $22.77 | $33.45 |
Delta Dental - Basic
| Cost Component | Empl Only (T1A/P1A) | Empl + Spouse (T2A/P2A) | Empl + Child(ren) (T3A/P3A) | Empl + Spouse + Child(ren) (T4A/P4A) |
|---|
| Administrative Cost | $19.31 | $36.25 | $38.04 | $54.98 |
| Premium | $38.62 | $72.50 | $76.08 | $109.96 |
| Total Rate | $57.93 | $108.75 | $114.12 | $164.94 |
Delta Dental - Basic Plus
| Cost Component | Empl Only (T1B/P1B) | Empl + Spouse (T2B/P2B) | Empl + Child(ren) (T3B/P3B) | Empl + Spouse + Child(ren) (T4B/P4B) |
|---|
| Administrative Cost | $23.85 | $45.10 | $47.34 | $68.60 |
| Premium | $47.70 | $90.20 | $94.68 | $137.20 |
| Total Rate | $71.55 | $135.30 | $142.02 | $205.80 |
FY2025 - Life Insurance Rates
Basic Life And AD&D Insurance
Monthly Premium Rates are Per Employee Per Month (100% State-Paid)
| Age Bracket | Basic Life Rate Per Employee Per Month | Basic AD&D Rate Per Employee Per Month | Total Basic Life And AD&D Rate Per Employee Per Month |
|---|
| None | $7.28 | $1.60 | $8.88 |
Employee Optional Life And AD&D Insurance
Monthly Premium Rates are for $1,000 of Coverage (100% Employee Paid)
| Age Bracket | Employee Optional Life Rate Per $1,000 Per Month | Employee Optional AD&D Rate Per $1,000 Per Month | Total Employee Optional Life and AD&D Rate Per $1,000 Per Month |
|---|
| Under Age 20 | $0.04 | $0.02 | $0.06 |
| 20-24 | $0.04 | $0.02 | $0.06 |
| 25-29 | $0.04 | $0.02 | $0.06 |
| 30-34 | $0.06 | $0.02 | $0.08 |
| 35-39 | $0.06 | $0.02 | $0.08 |
| 40-44 | $0.08 | $0.02 | $0.10 |
| 45-49 | $0.08 | $0.02 | $0.10 |
| 50-54 | $0.10 | $0.02 | $0.12 |
| 55-59 | $0.24 | $0.02 | $0.26 |
| 60-64 | $0.38 | $0.02 | $0.40 |
| 65-69 | $0.78 | $0.02 | $0.80 |
| Age 70 And Over | $1.20 | $0.02 | $1.22 |
Reminder: The Age Used for an Employee's Premium Calculation, From 1/1/2024 To 12/31/2024, will be the Employee's Age as of 12/31/2023.
Spouse Optional Life And AD&D Insurance
Monthly Premium Rates are for $1,000 of Coverage (100% Employee Paid)
| Age Bracket | Spouse Optional Life Rate Per $1,000 Per Month | Spouse Optional AD&D Rate Per $1,000 Per Month | Total Spouse Optional Life and AD&D Rate Per $1,000 Per Month |
|---|
| Under Age 20 | $0.06 | $0.02 | $0.08 |
| 20-24 | $0.06 | $0.02 | $0.08 |
| 25-29 | $0.06 | $0.02 | $0.08 |
| 30-34 | $0.08 | $0.02 | $0.10 |
| 35-39 | $0.10 | $0.02 | $0.12 |
| 40-44 | $0.10 | $0.02 | $0.12 |
| 45-49 | $0.16 | $0.02 | $0.18 |
| 50-54 | $0.24 | $0.02 | $0.26 |
| 55-59 | $0.44 | $0.02 | $0.46 |
| 60-64 | $0.66 | $0.02 | $0.68 |
| 65-69 | $1.32 | $0.02 | $1.34 |
| Age 70 And Over | $2.10 | $0.02 | $2.12 |
Reminder: The age used for a spouse's premium calculation, from 1/1/2024 To 12/31/2024, will be the spouse's age as of 12/31/2023.
Child Optional Life And AD&D Insurance
Monthly premium rates are per family unit (100% Employee Paid)
| Election Amount | Child Optional Life Rate Per Family Unit Per Month | Child Optional AD&D Rate Per Family Unit Per Month | Total Child Optional Life And AD&D Rate Per Family Unit Per Month |
|---|
| $5,000 | $0.40 | $0.10 | $0.50 |
| $10,000 | $0.80 | $0.20 | $1.00 |
FY2025 - STD & LTD Rates
Short-Term Disability (STD) Insurance Rates
Monthly premium rate is a percentage of an employee's monthly covered compensation (100% State Paid).
STD Premium Rate: 0.15% (0.0015) of monthly covered compensation effective 7/1/2024.
Optional Long-Term Disability (LTD) Insurance
The monthly LTD premiums are 100% Employee Paid.
The monthly LTD premium rates are a percentage of an employee's monthly covered compensation.
| Age | Pera DB Vested Option | Pera DB Non-Vested or DC Option |
|---|
| Under Age 30 | 0.0008 | 0.0025 |
| 30-34 | 0.0008 | 0.0025 |
| 35-39 | 0.0010 | 0.0034 |
| 40-44 | 0.0013 | 0.0037 |
| 45-49 | 0.0017 | 0.0052 |
| 50-54 | 0.0026 | 0.0079 |
| 55-59 | 0.0040 | 0.0118 |
| 60-64 | 0.0055 | 0.0174 |
| 65-69 | 0.0059 | 0.0178 |
| Age 70 And Over | 0.0072 | 0.0216 |
Reminder: The age used for an employee's Premium Calculation, from 1/1/2024 to 12/31/2024, will be the employee's age as of 12/31/2023.
