Employee Contributions | Intact Insurance Specialty Solutions Benefits

EMPLOYEE CONTRIBUTIONS

Intact has a salary-based contribution schedule for medical and dental benefits (for employees who work 30+ hours a week, and a separate contribution schedule for employees who work between 20-30 hours a week).

Medical

Employee medical plan biweekly contributions for employees regularly scheduled to work 30 or more hours per week.

Salary Band	Bi-Weekly Contributions
1. < $50,000	HRA	HSA
Employee Only	$63.15	$32.67
Employee + Spouse	$242.61	$150.29
Employee + Child(ren)	$123.65	$59.22
Family	$303.11	$165.89
2. $50,001 - $100,000	HRA	HSA
Employee Only	$66.65	$34.49
Employee + Spouse	$256.09	$158.64
Employee + Child(ren)	$130.52	$62.51
Family	$319.95	$175.10
3. $100,001 - 150,000	HRA	HSA
Employee Only	$70.16	$36.30
Employee + Spouse	$269.56	$166.98
Employee + Child(ren)	$137.39	$65.80
Family	$336.79	$184.32
4. $150,001 - 200,000	HRA	HSA
Employee Only	$75.07	$38.84
Employee + Spouse	$288.43	$178.67
Employee + Child(ren)	$147.01	$70.40
Family	$360.36	$197.22
5. $200,001 +	HRA	HSA
Employee Only	$78.58	$40.66
Employee + Spouse	$301.91	$187.02
Employee + Child(ren)	$153.88	$73.69
Family	$377.20	$206.44

Dental

Employee dental plan biweekly contributions for employees regularly scheduled to work 30 or more hours per week.

Salary Band	Bi-Weekly Contributions
1. < $50,000	Basic	Enhanced
Employee Only	$5.81	$15.59
Employee + Spouse	$14.39	$35.40
Employee + Child(ren)	$11.33	$30.38
Family	$19.14	$48.95
2. $50,001 - $100,000	Basic	Enhanced
Employee Only	$6.14	$16.45
Employee + Spouse	$15.19	$37.36
Employee + Child(ren)	$11.96	$32.07
Family	$20.21	$51.67
3. $100,001 - 150,000	Basic	Enhanced
Employee Only	$6.46	$17.32
Employee + Spouse	$15.99	$39.33
Employee + Child(ren)	$12.59	$33.76
Family	$21.27	$54.39
4. $150,001 - 200,000	Basic	Enhanced
Employee Only	$7.04	$18.88
Employee + Spouse	$17.43	$42.87
Employee + Child(ren)	$13.72	$36.80
Family	$23.18	$59.29
5. $200,001 +	Basic	Enhanced
Employee Only	$7.43	$19.92
Employee + Spouse	$18.39	$45.23
Employee + Child(ren)	$14.48	$38.82
Family	$24.46	$62.55

Part-time Employees

Employee medical and dental plan biweekly contributions for employees regularly scheduled to work between 20 to 30 hours per week.

Medical	HRA	HSA
Employee Only	$140.33	$72.60
Employee + Spouse	$539.13	$333.97
Employee + Child(ren)	$274.79	$131.60
Family	$673.58	$368.64

Dental	Basic	Enhanced
Employee Only	$12.92	$22.87
Employee + Spouse	$31.98	$53.37
Employee + Child(ren)	$25.18	$44.59
Family	$42.54	$72.90

EyeMed Vision Plan

Biweekly Contributions
Coverage Election
Employee	$4.16
Employee + Spouse	$8.26
Employee + Child(ren)	$9.09
Employee + Family	$12.68

Group Legal

The biweekly cost for the group legal plan is $8.42.

Long-Term Disability

To estimate your costs:

Basic LTD calculation = [(Base Salary + target STIP) / 100 x 0.1609]/26 = Biweekly amount
Supplemental LTD calculation = [(Base Salary + target STIP) / 100 x 0.29]/26 = biweekly amount

Rates
	LTD Plan rates per $100 of coverage
Basic (Mandatory) - 60%	$0.1609
Plus - 70%	$0.29

Optional AD&D

To estimate your costs:

[Amount of Coverage (1 - 6 times salary)/1,000 x rate] / 26 = Biweekly cost

Optional AD&D Rates
Coverage Level	Rate/$1,000
Employee only	$0.264
Employee & Family	$0.48

Life Insurance

To estimate your costs:

[Amount of Coverage (1 - 6 times salary)/1,000 x rate] / 26 = Biweekly cost

*The definition of a smoker is the use of tobacco products within the past 12 months (cigars, cigarettes, pipes, chewing tobacco)
Rates - Supplemental Employee Life
Age Band	Optional Life Insurance Rates per $1,000 coverage	Optional Life Insurance Rates per $1,000 coverage
	Smoker*	Non-Smoker
Less than 25	$0.528	$0.432
25-29	$0.612	$0.54
30-34	$0.876	$0.696
35-39	$0.948	$0.78
40-44	$1.044	$0.876
45-49	$1.74	$1.38
50-54	$2.76	$2.34
55-59	$5.16	$4.26
60-64	$6.864	$5.724
65-69	$13.20	$11.04
70+	$21.36	$17.88

*The definition of a smoker is the use of tobacco products within the past 12 months (cigars, cigarettes, pipes, chewing tobacco)
Rates - Spouse Life
Age Band	Optional Life Insurance Rates per $1,000 coverage	Optional Life Insurance Rates per $1,000 coverage
	Smoker*	Non-Smoker
Less than 25	$0.648	$0.528
25-29	$0.744	$0.636
30-34	$1.056	$0.852
35-39	$1.176	$0.96
40-44	$1.272	$1.056
45-49	$2.124	$1.704
50-54	$3.612	$2.868
55-59	$7.008	$5.208
60-64	$8.40	$6.996
65-69	$16.128	$13.476
70+	$26.208	$21.864

Child(ren) Life
Volume	Annual Premium
$5,000	$8.64
$10,000	$17.28
$15,000	$25.92

COBRA Rates and Contacts

Access COBRA ratates and vendor contact information here.

Intact Insurance Specialty Solutions is the marketing brand for the insurance company subsidiaries of Intact Insurance Group USA LLC. Coverages may be underwritten by one of the following insurance companies: Atlantic Specialty Insurance Company, a New York insurer; Homeland Insurance Company of New York, a New York insurer; Homeland Insurance Company of Delaware, a Delaware insurer; OBI America Insurance Company, a Pennsylvania insurer; OBI National Insurance Company, a Pennsylvania insurer; or The Guarantee Company of North America USA, a Michigan insurer. Each of these insurers maintains its principal place of business at 605 Highway 169 N, Plymouth, MN 55441, except The Guarantee Company of North America USA, which is located at One Towne Square, Southfield, MI 48076. This material is intended as a general description of certain types of insurance coverages and services. Coverages and availability vary by state; exclusions and deductibles may apply. Please refer to your insurance policy or consult with your independent insurance advisor for information about coverages, terms and conditions. Some coverage may be written by a surplus lines insurer through a licensed surplus lines broker. Surplus lines insurers do not generally participate in state guaranty funds and insureds are therefore not protected by such funds.