Employee Contributions

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Effective January 1, 2024

Your cost for coverage under the PCOC benefit plans depends on how many eligible dependents you enroll and what benefit choices you make.

PCOC pays 100% of the medical premiums for your coverage and 25% for your dependent coverage. You pay 75% of the medical premiums for your spouse/domestic partner, all your dependent children age 21 and over and only your three oldest dependent children under the age of 21. Age is calculated using your dependent’s age as of enrollment date. If you need assistance calculating your medical premiums, contact the PCOC Benefits Service Center or Human Resources.

Medical, dental, vision, flexible spending account, transportation management account and 401(k) contributions are deducted from your pay on a pretax basis. Unless claimed as your federal tax dependent under Internal Revenue Code Section 152, coverage for a domestic partner is deducted on an after-tax basis.

In addition, you are subject to domestic partner imputed income on your federal taxes if you enroll a domestic partner. A child of your domestic partner is eligible for coverage only if they are claimed as your federal tax dependent. Contact Human Resources for more information.

Company-Paid Plans

The following coverages are provided at no cost to you:

  • Employee Only Medical.
  • Employee Only Dental.
  • Long Term Disability.
  • Basic Life.
  • Basic AD&D.
  • Employee Assistance Program.
Medical (Biweekly Employee Contributions)
Age Range*
0 - 14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65 +
Medical (Biweekly Employee Contributions)
Blue Shield of CA Platinum PPO
$186.96
$203.58
$209.94
$216.29
$223.13
$229.98
$237.06
$244.39
$244.39
$244.39
$244.39
$245.37
$250.26
$256.13
$265.66
$273.48
$277.38
$283.25
$289.12
$292.78
$296.70
$298.65
$300.60
$302.56
$304.51
$308.42
$312.34
$318.20
$323.82
$331.64
$341.42
$352.91
$366.59
$381.99
$399.58
$416.94
$436.49
$455.79
$477.06
$498.56
$521.78
$545.00
$570.17
$595.59
$622.72
$636.16
$663.29
$686.75
$702.14
$721.45
$733.18
$733.18
Medical (Biweekly Employee Contributions)
Blue Shield of CA Platinum HMO
$160.94
$175.25
$180.72
$186.19
$192.08
$197.97
$204.07
$210.38
$210.38
$210.38
$210.38
$211.22
$215.43
$220.48
$228.68
$235.42
$238.78
$243.83
$248.88
$252.04
$255.40
$257.09
$258.77
$260.45
$262.14
$265.50
$268.87
$273.92
$278.76
$285.49
$293.90
$303.79
$315.57
$328.83
$343.98
$358.91
$375.74
$392.36
$410.66
$429.18
$449.16
$469.15
$490.82
$512.70
$536.05
$547.62
$570.97
$591.17
$604.43
$621.05
$631.14
$631.14
Medical (Biweekly Employee Contributions)
Blue Shield of CA Gold PPO
$168.42
$183.40
$189.12
$194.85
$201.01
$207.18
$213.56
$220.17
$220.17
$220.17
$220.17
$221.04
$225.45
$230.73
$239.32
$246.36
$249.89
$255.17
$260.46
$263.76
$267.28
$269.04
$270.80
$272.57
$274.32
$277.85
$281.37
$286.66
$291.72
$298.76
$307.57
$317.92
$330.25
$344.12
$359.97
$375.60
$393.22
$410.61
$429.76
$449.14
$470.05
$490.97
$513.65
$536.54
$560.98
$573.09
$597.53
$618.66
$632.54
$649.93
$660.50
$660.50
Medical (Biweekly Employee Contributions)
Blue Shield of CA Gold HMO
$152.06
$165.58
$170.75
$175.92
$181.48
$187.05
$192.81
$198.77
$198.77
$198.77
$198.77
$199.57
$203.54
$208.32
$216.06
$222.43
$225.61
$230.38
$235.15
$238.13
$241.31
$242.90
$244.49
$246.08
$247.67
$250.85
$254.03
$258.80
$263.37
$269.74
$277.68
$287.03
$298.16
$310.68
$324.99
$339.11
$355.01
$370.71
$388.01
$405.50
$424.38
$443.27
$463.74
$484.41
$506.47
$517.41
$539.47
$558.55
$571.08
$586.78
$596.32
$596.32
Medical (Biweekly Employee Contributions)
Domestic Partner Imputed Income**
Individually determined
Dental (Biweekly Employee Contributions)
Plan
Delta Dental PPO
DeltaCare USA HMO
Dental (Biweekly Employee Contributions)
Employee Only
$0.00
$0.00
Dental (Biweekly Employee Contributions)
Employee + 1 Dependent
$9.19
$2.76
Dental (Biweekly Employee Contributions)
Employee + 2 or More Dependents
$21.46
$5.77
Dental (Biweekly Employee Contributions)
Domestic Partner Imputed Income**
$9.19
$2.76
Vision (Biweekly Employee Contributions)
Plan
VSP Choice Plan B
Vision (Biweekly Employee Contributions)
Employee Only
$3.73
Vision (Biweekly Employee Contributions)
Employee + 1 Dependent
$6.31
Vision (Biweekly Employee Contributions)
Employee + 2 or More Dependents
$10.47

* Age is calculated using your dependent’s age as of enrollment date. PCOC pays 100% of the medical premiums for your coverage and 25% for your dependent coverage. You pay 75% of the medical premiums for your spouse/domestic partner, all your dependent children age 21 and over and only your three oldest dependent children under the age of 21. If you need assistance calculating your medical premiums, contact the PCOC Benefits Service Center or Human Resources.

** In accordance with the IRS, PCOC’s cost of providing benefits for domestic partners who do not meet the IRC Section 152 definition of qualified dependents is considered ordinary or imputed income and is, therefore, subject to taxes. You will be required to pay for the cost of your domestic partner’s coverage on an after-tax basis; in addition, the imputed income listed above will be added to your W-2 wages when your domestic partner is not your tax dependent. Contact Human Resources for more information.