SUPPLEMENTAL COVERAGE RATES 2021-2022
SPOUSE/DOMESTIC PARTNER………. $34.44 per paycheck
EACH DEPENDENT……………… $ 20.00 per paycheck
EMPLOYEE DEDUCTIONS FOR SPOUSE, DOMESTIC PARNTER AND CHILDREN – ANNUAL AND PER CHECK
| CATEGORY | ANNUAL COST | PER CHECK |
| Spouse/Partner Only | $ 620.00 | $ 34.44 |
| 1 Dependent | 360.00 | 20.00 |
| 2 Dependents | 720.00 | 40.00 |
| 3 Dependents | 1,080.00 | 60.00 |
| 4 Dependents | 1,440.00 | 80.00 |
| 5 Dependents | 1,800.00 | 100.00 |
| Spouse + 1Dep | 980.00 | 54.44 |
| Spouse + 2 Dep | 1,340.00 | 74.44 |
| Spouse + 3 Dep | 1,700.00 | 94.44 |
| Spouse + 4 Dep | 2,060.00 | 114.44 |
| Spouse + 5 Dep | 2,420.00 | 134.44 |
CATEGORY ANNUAL COST PER CHECK
Starting with the October 15th paycheck, deductions can be found on your paycheck under PT_OCTDent
***Deductions are taken out beginning October 15th. No deductions for Supplemental Coverage are taken during July, August, September or the October 1st pay check.
Coverage for new enrollees begins on October 1st. Some Waiting periods apply. Please check your Benefits at a Glance or Benefit Fee Schedule