Ch. 78, PL 2011
Employee Benefits Contribution
Calculation Worksheet
10 Month Employee
Calculate Premium Percentage
1
Use the SEHBP Medical Premium (below) that applies to you:
$
1,403.88
Review the attached rate sheet for the plan you have selected, then locate the
rate for the type of coverage you have: single, family or other
2
Use the Percentage of Premium from Chart (attached):
3.00 %
There are three charts attached representing single, family or other coverage.
Using your annual salary, determine the proper rate for year one
3
Calculate your Medical Plan Contribution:
$
42.12
$
446.29
The formula provided will multiply the medical premium by the precentage,
or #1 above times #2 above.
4
Use the Rx rates below and enter the proper monthly amount:
Single: 166.92 Member/Spouse: $446.29, Family: $446.29 Parent/Child(ren):
$225.00 (if you selected a HD med plan enter zero)
5
Use the Percentage of Premium from Chart (attached):
3.00 %
There are three charts attached representing single, family or other coverage.
Using your annual salary, determine the proper rate for year one
6
Calculate your Prescription Plan Contribution:
$
13.39
$
55.51
The formula provided will multiply the prescription premium by the precentage,
or #4 above times #5 above.
7
Add lines #3 and #6 from above:
This will be your medical and prescription contribution spread over 12 months
This is the amount spread over 10 months (for 10 month employees)
66.61 ↙
Calculate Salary Percentage
8
Enter your annual salary:
9
Percentage rate as set by the state for salary percentage
10 Multiply your annual salary by the percentage of 1.5:
$
9,000.00
1.5 %
$
135.00
The formula provided will multiply #8 by #9
10
11 Enter the number of months you work: 10
12 month employees
12 Percentage of salary for benefits contribution:
$
13.50 ↙
$
66.61
The formula provided will divide #10 by #11
Your Monthly Benefit Contribution
13 The formula will calculate the larger of line #7 or line #12
Your Benefit Contribution Per Pay
14 This formula will calculate your per pay contribution
33.30
Ch. 78, PL 2011
Employee Benefits Contribution
Calculation Worksheet
SINGLE COVERAGE
Salary Range
less than 20,000
20,000-24,999.99
25,000-29,999.99
30,000-34,999.99
35,000-39,999.99
40,000-44,999.99
45,000-49,999.99
50,000-54,999.99
55,000-59,999.99
60,000-64,999.99
65,000-69,999.99
70,000-74,999.99
75,000-79,999.99
80,000-94,999.99
95,000 and over
Year 1
1.13%
1.38%
1.88%
2.50%
2.75%
3.00%
3.50%
5.00%
5.75%
6.75%
7.25%
8.00%
8.25%
8.50%
8.75%
Year 2
2.25%
2.75%
3.75%
5.00%
5.50%
6.00%
7.00%
10.00%
11.50%
13.50%
14.50%
16.00%
16.50%
17.00%
17.50%
Year 3
3.38%
4.13%
5.63%
7.50%
8.25%
9.00%
10.50%
15.00%
17.25%
20.25%
21.75%
24.00%
24.75%
25.50%
26.25%
Year 4
4.50%
5.50%
7.50%
10.00%
11.00%
12.00%
14.00%
20.00%
23.00%
27.00%
29.00%
32.00%
33.00%
34.00%
35.00%
FAMILY COVERAGE
Salary Range
less than 25,000
25,000-29,999.99
30,000-34,999.99
35,000-39,999.99
40,000-44,999.99
45,000-49,999.99
50,000-54,999.99
55,000-59,999.99
60,000-64,999.99
65,000-69,999.99
70,000-74,999.99
75,000-79,999.99
80,000-84,999.99
85,000-89,999.99
90,000-94,999.99
95,000-99,999.99
100,000-109,999.99
110,000 and over
Year 1
0.75%
1.00%
1.25%
1.50%
1.75%
2.25%
3.00%
3.50%
4.25%
4.75%
5.50%
5.75%
6.00%
6.50%
7.00%
7.25%
8.00%
8.75%
Year 2
1.50%
2.00%
2.50%
3.00%
3.50%
4.50%
6.00%
7.00%
8.50%
9.50%
11.00%
11.50%
12.00%
13.00%
14.00%
14.50%
16.00%
17.50%
Year 3
2.25%
3.00%
3.75%
4.50%
5.25%
6.75%
9.00%
10.50%
12.75%
14.25%
16.50%
17.25%
18.00%
19.50%
21.00%
21.75%
24.00%
26.25%
Year 4
3.00%
4.00%
5.00%
6.00%
7.00%
9.00%
12.00%
14.00%
17.00%
19.00%
22.00%
23.00%
24.00%
26.00%
28.00%
29.00%
32.00%
35.00%
Member & Spouse/Partner or Parent& Child(ren) Coverage
Salary Range
Year 1
Year 2
less than 25,000
0.88%
1.75%
25,000-29,999.99
1.13%
2.25%
30,000-34,999.99
1.50%
3.00%
35,000-39,999.99
1.75%
3.50%
40,000-44,999.99
2.00%
4.00%
45,000-49,999.99
2.50%
5.00%
50,000-54,999.99
3.75%
7.50%
55,000-59,999.99
4.25%
8.50%
60,000-64,999.99
5.25%
10.50%
65,000-69,999.99
5.75%
11.50%
70,000-74,999.99
6.50%
13.00%
75,000-79,999.99
6.75%
13.50%
80,000-84,999.99
7.00%
14.00%
85,000-99,999.99
7.50%
15.00%
100,000 and over
8.75%
17.50%
Year 3
2.63%
3.38%
4.50%
5.25%
6.00%
7.50%
11.25%
12.75%
15.75%
17.25%
19.50%
20.25%
21.00%
22.50%
26.25%
Year 4
3.50%
4.50%
6.00%
7.00%
8.00%
10.00%
15.00%
17.00%
21.00%
23.00%
26.00%
27.00%
28.00%
30.00%
35.00%
2012
Single
Member/Spouse
Family
Parent/Child
Direct 10
Direct 15
Direct 1525
Direct 2030
561.55
1123.1
1403.88
831.09
534.58
1069.16
1336.45
791.18
518.82
1037.64
1297.06
767.85
487.59
975.19
1218.99
721.64
* These rates are effective 1/1/2012, and are subject to change on 1/1/2013
2012
Single
Member/Spouse
Family
Parent/Child
Aetna HMO
Aenta 1525
Aetna 2030
547.56
1095.12
1368.9
810.39
505.62
1011.23
1264.04
748.31
475.45
950.89
1188.62
703.66
* These rates are effective 1/1/2012, and are subject to change on 1/1/2013
2012
Single
Member/Spouse
Family
Parent/Child
Cigna HMO
Cigna 1525
Cigna 2030
550.57
1101.14
1376.43
814.84
508.4
1016.79
1271.00
752.42
478.06
956.12
1195.15
707.53
* These rates are effective 1/1/2012, and are subject to change on 1/1/2013
2012
Single
Member/Spouse
Family
Parent/Child
NJ Direct 10
HD1500
Aetna
HD1500
Cigna
HD1500
583.32
1166.63
1458.29
863.3
571.91
1143.82
1429.77
846.42
574.36
1148.72
1435.91
850.05
These rates include the medical and prescription plans.
Be sure to enter zero in the worksheet for the prescription plan.
* These rates are effective 1/1/2012, and are subject to change on 1/1/2013