Page 16 - Venafi - 2021 Benefit Guide - CA

medical, dental, and vision rates

Medical Insurance Rates Medical Opt Out Option

United Healthcare - Traditional Copay Plan (Options) Who is waiving What are you eligible for Monthly Amount
Just myself Single $100
Team Member VENAFI PREMIUM COST
Premium Monthly Annually Myself & my spouse Team Member + Spouse $200
Team Member (TM) Only $0.00 $673.71 $8,084.52 Myself & my children Team Member + Child(ren) $200
TM + Spouse/Domestic Partner $0.00 $1,489.71 $17,876.52 Myself & my entire family Team Member + Family $250
TM + Child(ren) $0.00 $1,422.37 $17,068.44 Only my spouse Team Member + Spouse $100

TM + Family $0.00 $2,103.32 $25,239.84 Only my child(ren) Family $100
My spouse & my child(ren) Family $200
United Healthcare - High Deductible Health Plan (Options)

Team Member VENAFI PREMIUM COST Dental Insurance Rates
Premium Monthly Annually
Team Member (TM) Only $0.00 $548.53 $6,582.36 Cigna - PPO Plan
TM + Spouse/Domestic Partner $0.00 $1,212.84 $14,554.08 Team Member VENAFI PREMIUM COST
Premium Monthly Annually
TM + Child(ren) $0.00 $1,158.06 $13,896.72
TM + Family $0.00 $1,712.40 $20,548.80 Team Member (TM) Only $0.00 $53.59 $643.08
TM + 1 Dependent $0.00 $106.49 $1,277.88
Venafi Health Savings Account Contributions TM + Family $0.00 $164.99 $1,979.88

IRS Annual VENAFI HSA CONTRIBUTIONS
Maximum Monthly Annually Vision Insurance Rates
Team Member (TM) Only $3,600 $100.00 $1,200
TM + Spouse/Domestic Partner $7,200 $208.33 $2,500 Cigna - PPO Plan
TM + Child(ren) $7,200 $208.33 $2,500 Team Member VENAFI PREMIUM COST
Premium Monthly Annually
TM + Family $7,200 $266.67 $3,200
Team Member (TM) Only $0.00 $6.36 $76.32
TM + Spouse/Domestic Partner $0.00 $12.73 $152.76
TM + Child(ren) $0.00 $12.86 $154.32
TM + Family $0.00 $20.52 $246.24

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