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City of St Anthony <br />2019 Premium and Employer Contributions <br />Staff opting -out must provide reasonable evidence that the employee and all individuals for whom the <br />employee reasonably expects to claim a personal exemption deduction for the taxable year has <br />coverage in place <br />2019 <br />City <br />-HSA <br />ployee cost <br />Health Insurance <br />Contribution <br />ch pay period <br />f <br />Plan <br />Coverage <br />(monthly) <br />24 payrolls) <br />25 Co -Pay <br />Single <br />871.50 <br />- <br />500 deductible <br />EE a Spouse <br />1,830.50 <br />202.60 <br />Achieve <br />EE a Children <br />1,743.50 <br />168.13 <br />Family <br />2,26 <br />68 <br />2700 <br />Open Access <br />:EE Et Spouse <br />1,412.00 <br />80.00 <br />EE Et Children <br />1,344.50 <br />56.88 <br />Farnily <br />1,7400 <br />F- -"Zlll�Ill'I.I.PprnmmmrmmmmmmMEPMPMMF= <br />2700 H.S.A. <br />Single <br />659.00 <br />225.00 <br />Perform <br />EE a Spouse <br />1,383.50 <br />64.00 <br />EE a Children <br />1,317.50 <br />41.62 <br />Family <br />1,713.00 <br />109.25 <br />2700 H.S.A. <br />Single <br />645.50 <br />225.00 <br />Achieve <br />EE a Spouse <br />1 355.50 <br />39.59 <br />EE a Children <br />1 291.00 <br />39.22 <br />. MIA <br />M <br />000 <br />'Open <br />Spouse <br />i EE Et Children <br />1 240.50 <br />11.50 <br />Family <br />1,6100 <br />4000 H.S.A. <br />Single <br />608.00 <br />225.00 <br />- <br />Perform <br />EE a Spouse <br />1,276.50 <br />- <br />18.13 <br />EE a Children <br />1,216.00 <br />4.50 <br />- <br />Family <br />1,580.00 <br />- <br />51.87 <br />Single <br />595.50 <br />225.00 <br />- <br />EE a Spouse <br />250 .50 <br />- <br />14.99 <br />EE a Children <br />,191.00 <br />Ll <br />6.2 ° <br />FaMjj , ,�0 <br />29,.60 <br />Staff opting -out must provide reasonable evidence that the employee and all individuals for whom the <br />employee reasonably expects to claim a personal exemption deduction for the taxable year has <br />coverage in place <br />