Employee selection is created by each individual, because the rates are based on age and other factors.
| Benefits | Carrier | Plan | Employer Contribution: Employee | Employer Contribution: Sp/Dep | Waiting Period | Last day | Re-hire Waiting Period |
|---|---|---|---|---|---|---|---|
| Medical | Medical Mutual of Ohio | HSA 5000 | 100% Employee Only | 0% | Exactly 90 days from date of Hire | End of the Month | Exactly 90 days from date of re-Hire |
| Medical | Medical Mutual of Ohio | SMP_30/2000 | 100% Employee Only | 0% | Exactly 90 days from date of Hire | End of the Month | Exactly 90 days from date of re-Hire |
| Dental | Medical Mutual of Ohio | DEN VALUE PPO1 CYMAX VOLUNTARY NO ORTHO | 100% Employee Only | 0% | Exactly 90 days from date of Hire | End of the Month | Exactly 90 days from date of re-Hire |
| Age | EE Male | Female Spouse | EE Female | Male Spouse | Primary | Children |
|---|---|---|---|---|---|---|
| 000 TO 024 | $239.23 | $703.69 | $497.94 | $253.84 | $749.96 | $606.90 |
| 025 TO 029 | $272.71 | $785.26 | $593.50 | $287.32 | $749.96 | $606.90 |
| 030 TO 034 | $334.80 | $790.13 | $713.43 | $334.80 | $749.96 | $606.90 |
| 035 TO 039 | $406.63 | $742.05 | $756.65 | $406.63 | $749.96 | $606.90 |
| 040 TO 044 | $478.47 | $722.56 | $698.82 | $502.82 | $749.96 | $606.90 |
| 045 TO 049 | $588.64 | $818.74 | $760.92 | $617.25 | $749.96 | $606.90 |
| 050 TO 054 | $722.56 | $952.66 | $890.58 | $827.88 | $749.96 | $606.90 |
| 055 TO 059 | $952.66 | $1,067.71 | $967.27 | $1,062.85 | $749.96 | $606.90 |
| 060 TO 064 | $1,211.38 | $1,249.73 | $1,153.54 | $1,417.12 | $749.96 | $606.90 |
| 065 TO 105 | $1,536.44 | $1,435.99 | $1,292.32 | $1,838.37 | $749.96 | $606.90 |
| Age | EE Male | Female Spouse | EE Female | Male Spouse | Child / Children | Medicare |
|---|---|---|---|---|---|---|
| 000 TO 024 | $145.69 | $422.86 | $301.15 | $152.53 | $364.70 | $450.67 |
| 025 TO 029 | $165.81 | $471.88 | $358.58 | $172.66 | $364.70 | $450.67 |
| 030 TO 034 | $203.12 | $474.80 | $430.64 | $201.19 | $364.70 | $450.67 |
| 035 TO 039 | $246.29 | $445.90 | $456.61 | $244.36 | $364.70 | $450.67 |
| 040 TO 044 | $289.44 | $434.20 | $421.86 | $302.15 | $364.70 | $450.67 |
| 045 TO 049 | $355.65 | $492.00 | $459.17 | $370.92 | $364.70 | $450.67 |
| 050 TO 054 | $436.13 | $572.47 | $537.09 | $497.48 | $364.70 | $450.67 |
| 055 TO 059 | $574.40 | $641.60 | $583.18 | $638.68 | $364.70 | $450.67 |
| 060 TO 064 | $729.87 | $750.98 | $695.12 | $851.57 | $364.70 | $450.67 |
| 065 TO 105 | $925.20 | $862.92 | $778.51 | $1,104.70 | $364.70 | $450.67 |
| Age | EE Male | Female Spouse | EE Female | Male Spouse | Child/(ren) |
|---|---|---|---|---|---|
| 000 TO 024 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 025 TO 029 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 030 TO 034 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 035 TO 039 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 040 TO 044 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 045 TO 049 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 050 TO 054 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 055 TO 059 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 060 TO 064 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| 065 TO 105 | $27.86 | $27.86 | $27.86 | $27.86 | $41.51 |
| Contribution and Out-of-Pocket Limits for Health Savings Accounts and High-Deductible Health Plans |
|||
|---|---|---|---|
| 2022 | 2021 | Change | |
| HSA contribution limit (employer + employee) | Self-only: $3,650 Family: $7,300 |
Self-only: $3,600 Family: $7,200 |
Self-only: +$50 Family: +$100 |
| HSA catch-up contributions (age 55 or older) | $1,000 | $1,000 | No change |
| HDHP minimum deductibles | Self-only: $1,400 Family: $2,800 |
Self-only: $1,400 Family: $2,800 |
No change No change |
|
HDHP maximum out-of-pocket amounts (deductibles, co-payments and other amounts, but not premiums) |
Self-only: $7,050 Family: $14,100 |
Self-only: $7,000 Family: $14,000 |
Self-only: +$50 Family: +$100 |
| Source: IRS, Revenue Procedure 2021-25. | |||