BNY Mellon Benefits Guide
2016 Monthly Medical Contributions
The table below shows 2016 monthly health plan contribution rates for eligible full-time and part-time employees, based on annual base pay and assuming the Live Well premium savings were earned. (Your base pay for the 2016 plan year is determined as of September 1, 2015, for existing employees or as of your date of hire, if later.) The rates shown include Live Well premium savings for newly eligible employees who automatically receive these savings during the first year of coverage. To verify your contribution rate after enrollment, go to MyBenefit Solutions. At work: MySource > MyReward > Log on to MyReward > Proceed to My Personal Total Reward Data > MyBenefit Solutions. From home:
http://mybenefits.bnymellon.com.
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2016 MONTHLY CONTRIBUTIONS
(TO CALCULATE YOUR PER-PAY COST, DIVIDE THE NUMBER BELOW BY TWO)
(FIGURES ASSUME EMPLOYEE/SPOUSE/DOMESTIC PARTNER LIVE WELL PREMIUM SAVINGS WERE EARNED)
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PLAN HRA
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PLAN HSA
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PREFERRED CARRIER RATE
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NON- PREFERRED CARRIER RATE
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PREFERRED CARRIER RATE
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NON- PREFERRED CARRIER RATE
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KAISER PLAN
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AETNA INTER-NATIONAL
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Under $30,000
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Employee
|
$49
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$55
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$13
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$15
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$47
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$49
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|
Employee + Child(ren)
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$98
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$110
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$26
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$29
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$94
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$98
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Employee + Spouse/Domestic Partner
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$108
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$121
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$29
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$32
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$103
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$108
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Employee + Family
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$167
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$187
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$44
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$49
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$160
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$167
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$30,000 - $39,999
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Employee
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$76
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$85
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$20
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$22
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$77
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$80
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Employee + Child(ren)
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$152
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$170
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$40
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$45
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$154
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$160
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Employee + Spouse/Domestic Partner
|
$167
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$187
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$44
|
$49
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$169
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$176
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Employee + Family
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$258
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$289
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$68
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$76
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$262
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$272
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$40,000 - $49,999
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|
Employee
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$89
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$100
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$23
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$26
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$96
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$102
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Employee + Child(ren)
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$178
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$199
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$46
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$52
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$192
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$204
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Employee + Spouse/Domestic partner
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$196
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$220
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$51
|
$57
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$211
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$224
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|
Employee + Family
|
$303
|
$339
|
$78
|
$87
|
$326
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$347
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$50,000 - $79,999
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|
Employee
|
$96
|
$108
|
$25
|
$28
|
$118
|
$131
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|
Employee + Child(ren)
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$192
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$215
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$50
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$56
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$236
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$262
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Employee + Spouse/Domestic Partner
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$211
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$236
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$55
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$62
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$260
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$288
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Employee + Family
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$326
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$365
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$85
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$95
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$401
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$445
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$80,000 - $99,999
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Employee
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$117
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$131
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$31
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$35
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$149
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$143
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Employee + Child(ren)
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$234
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$262
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$62
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$69
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$298
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$286
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Employee + Spouse/Domestic Partner
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$257
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$288
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$68
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$76
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$328
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$315
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Employee + Family
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$398
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$446
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$105
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$118
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$507
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$486
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$100,000 - $124,999
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|
Employee
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$161
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$180
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$42
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$47
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$173
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$214
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Employee + Child(ren)
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$322
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$361
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$84
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$94
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$346
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$428
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Employee + Spouse/Domestic Partner
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$354
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$396
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$92
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$103
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$381
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$471
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Employee + Family
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$547
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$613
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$143
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$160
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$588
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$728
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$125,000 -$149,999
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|
Employee
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$170
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$190
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$45
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$50
|
$214
|
$214
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|
Employee + Child(ren)
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$340
|
$381
|
$90
|
$101
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$428
|
$428
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|
Employee + Spouse/Domestic Partner
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$374
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$419
|
$99
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$111
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$471
|
$471
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Employee + Family
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$578
|
$647
|
$153
|
$171
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$728
|
$728
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$150,000 - $249,999
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|
Employee
|
$190
|
$213
|
$50
|
$56
|
$225
|
$246
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|
Employee + Child(ren)
|
$380
|
$426
|
$100
|
$112
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$450
|
$492
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|
Employee + Spouse/Domestic Partner
|
$418
|
$468
|
$110
|
$123
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$495
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$541
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|
Employee + Family
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$646
|
$724
|
$170
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$190
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$765
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$836
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$250,000 and above
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|
Employee
|
$210
|
$235
|
$55
|
$62
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$258
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$268
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|
Employee + Child(ren)
|
$420
|
$470
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$110
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$123
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$516
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$536
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Employee + Spouse/Domestic Partner
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$462
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$517
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$121
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$136
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$568
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$590
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Employee + Family
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$714
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$800
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$187
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$209
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$877
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$911
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