MonteCare EPO/MonteCare PPO
Bi-weekly Premiums
SALARY BAND UNDER $39,999 BI-WEEKLY PREMIUM
Full-time You Only
MonteCare EPO - $48.71
MonteCare PPO - $74.77
Full-time You and Your Family
MonteCare EPO - $136.39
MonteCare PPO - $209.43
Part-time You Only
MonteCare EPO - $63.34
MonteCare PPO - $139.43
Part-time You and Your Family
MonteCare EPO - $313.99
MonteCare PPO - $390.38
SALARY BAND $40,000 • $64,999 BI-WEEKLY PREMIUM
Full-time You Only
MonteCare EPO - $55.88
MonteCare PPO - $81.94
Full-time You and Your Family
MonteCare EPO - $156.45
MonteCare PPO - $229.40
Part-time You Only
MonteCare EPO - $117.40
MonteCare PPO - $144.68
Part-time You and Your Family
MonteCare EPO - $328.70
MonteCare PPO - $405.09
SALARY BAND $65,000 • $99,999 BI-WEEKLY PREMIUM
Full-time You Only
MonteCare EPO - $63.04
MonteCare PPO - $89.10
Full-time You and Your Family
MonteCare EPO - $176.51
MonteCare PPO - $249.46
Part-time You Only
MonteCare EPO - $122.65
MonteCare PPO - $149.93
Part-time You and Your Family
MonteCare EPO - $343.41
MonteCare PPO - $419.80
SALARY BAND $100,000 • $149,999 BI-WEEKLY PREMIUM
Full-time You Only
MonteCare EPO - $74.50
MonteCare PPO - $100.56
Full-time You and Your Family
MonteCare EPO - $208.60
MonteCare PPO - $281.55
Part-time You Only
MonteCare EPO - $131.05
MonteCare PPO - $158.34
Part-time You and Your Family
MonteCare EPO - $366.95
MonteCare PPO - $443.33
SALARY BAND $150,000 • $199,999 BI-WEEKLY PREMIUM
Full-time You Only
MonteCare EPO - $80.23
MonteCare PPO - $106.29
Full-time You and Your Family
MonteCare EPO - $224.65
MonteCare PPO - $297.60
Part-time You Only
MonteCare EPO - $135.25
MonteCare PPO - $162.54
Part-time You and Your Family
MonteCare EPO - $378.71
MonteCare PPO - $455.10
SALARY BAND $200,000 • $249,999 BI-WEEKLY PREMIUM
Full-time You Only
MonteCare EPO - $85.96
MonteCare PPO - $112.02
Full-time You and Your Family
MonteCare EPO - $240.70
MonteCare PPO - $313.65
Part-time You Only
MonteCare EPO - $139.46
MonteCare PPO - $166.74
Part-time You and Your Family
MonteCare EPO - $390.48
MonteCare PPO - $466.87
SALARY BAND $250,000 AND OVER BI-WEEKLY PREMIUM
Full-time You Only
MonteCare EPO - $91.69
MonteCare PPO - $117.75
Full-time You and Your Family
MonteCare EPO - $256.74
MonteCare PPO - $329.69
Part-time You Only
MonteCare EPO - $143.66
MonteCare PPO - $170.94
Part-time You and Your Family
MonteCare EPO - $402.25
MonteCare PPO - $478.63
UnitedHealthcare Vision Plan
Bi-weekly Premiums
LOW OPTION
You Only
$2.30
You and One Family Member
$4.10
You and Your Family
$6.95
HIGH OPTION
You Only
$3.54
You and One Family Member
$6.79
You and Your Family
$9.39
Dental
Bi-weekly Premiums
CIGNA DHMO
You Only
$8.57
You and Your Family
$21.43
PREVENTIVE & DIAGNOSTIC DENTAL CARE ONLY
You Only
Your first year at Montefiore • $3.37
After your first year at Montefiore • $0
You and Your Family
Your first year at Montefiore • $9.43
After your first year at Montefiore • $0
CIGNA DPPO DENTAL PLAN
You Only
Your first year at Montefiore • $17.76
After your first year at Montefiore • $8.52
You and Your Family
Your first year at Montefiore • $49.71
After your first year at Montefiore • $27.84
CIGNA DPPO ENHANCED DENTAL PLAN
You Only
Your first year at Montefiore • $22.20
After your first year at Montefiore • $12.96
You and Your Family
Your first year at Montefiore • $62.14
After your first year at Montefiore • $40.27
Life Insurance
Basic Life Insurance
Montefiore provides Basic Life Insurance – at no cost to you after you complete one year at Montefiore.
- Your Basic Life Insurance monthly premium is $0.08 for every $1,000 of your annual base salary.
- If you elect to opt down to $50,000, your monthly premium is $4.00 ($1.85 bi-weekly).
Supplemental Life Insurance
Under 25 Age Group
Non-nicotine user
$0.026 per $1,000
Nicotine user
$0.028 per $1,000
25-29 Age Group
Non-nicotine user
$0.028 per $1,000
Nicotine user
$0.030 per $1,000
30-34 Age Group
Non-nicotine user
$0.035 per $1,000
Nicotine user
$0.038 per $1,000
35-39 Age Group
Non-nicotine user
$0.044 per $1,000
Nicotine user
$0.046 per $1,000
40-44 Age Group
Non-nicotine user
$0.057 per $1,000
Nicotine user
$0.063 per $1,000
45-49 Age Group
Non-nicotine user
$0.091 per $1,000
Nicotine user
$0.101 per $1,000
50-54 Age Group
Non-nicotine user
$0.146 per $1,000
Nicotine user
$0.162 per $1,000
55-59 Age Group
Non-nicotine user
$0.249 per $1,000
Nicotine user
$0.277 per $1,000
60-64 Age Group
Non-nicotine user
$0.354 per $1,000
Nicotine user
$0.393 per $1,000
65-69 Age Group
Non-nicotine user
$0.598 per $1,000
Nicotine user
$0.664 per $1,000
70+ Age Group
Non-nicotine user
$0.939 per $1,000
Nicotine user
$1.043 per $1,000
Supplemental Life Insurance Premium Calculator
Dependent Life Insurance
If you elect Dependent Life Insurance, the bi-weekly cost is:
- $1.49 – $10,000 for your spouse; $5,000 for each child
- $2.97 – $20,000 for your spouse; $10,000 for each child.
AD&D Insurance
- Montefiore provides Basic AD&D Insurance – at no cost to you after you complete one year at Montefiore. Your Basic AD&D Insurance monthly premium is $0.014 for every $1,000 of your annual base salary.
Supplemental AD&D
For every $1,000 of coverage you elect, your Supplemental AD&D monthly premium is based on:
- $0.018 for yourself
- $0.018 for your spouse
- $0.015 for each child.
Group Legal Services
If you elect Group Legal Services, the bi-weekly cost is:
- $3.62 for yourself
- $4.85 for you and your family.