Monthly Plan Costs
Medical
Cigna OAP
Employee Only: $269.00
Employee and Spouse/DP: $592.00
Employee and Child(ren): $485.00
Employee and Family: $835.00
Cigna OAPIN
Employee Only: $301.00
Employee and Spouse/DP: $662.00
Employee and Child(ren): $541.00
Employee and Family: $932.00
Cigna HPHP
Employee Only: $215.00
Employee and Spouse/DP: $472.00
Employee and Child(ren): $386.00
Employee and Family: $665.00
Kaiser HMO
| <30 | 30-39 | 40-49 | 50-54 | 55-59 | 60-64 | 65+ | |
| Employee Only | $101.80 | $112.60 | $145.20 | $189.00 | $238.80 | $294.60 | $334.20 |
| Employee and Spouse/DP |
$284.40 | $305.80 | $334.00 | $392.80 | $501.60 | $559.60 | $722.20 |
| Employee and Child(ren) |
$279.80 | $287.80 | $275.80 | $311.80 | $357.00 | $394.00 | $502.40 |
| Employee and Family |
$395.80 | $437.80 | $440.80 | $502.20 | $577.00 | $653.20 | $794.00 |
Dental and Vision
Cigna Dental PPO
Employee Only: $12.00
Employee and Spouse/DP: $24.00
Employee and Child(ren): $31.00
Employee and Family: $43.00
The Standard Vision
Employee Only: $0.00
Employee and Spouse/DP: $0.00
Employee and Child(ren): $0.00
Employee and Family: $0.00
Domestic Partner Coverage
Please note that unless your domestic partner is your tax dependent as defined by the IRS, contributions for domestic partner coverage must be made after-tax. Similarly, the company contribution toward coverage for your domestic partner and his/her dependents will be reported as taxable income on your W-2. Contact your tax advisor for more details on how this tax treatment applies to you. Notify Azul if your domestic partner is your tax dependent.