Plan Costs

Cigna PPO Base

Employee Only: $XX

Employee and Spouse: $XX

Employee and Child(ren): $XX

Employee and Family: $XX

Cigna OAP Buy-Up

Employee Only: $XX

Employee and Spouse: $XX

Employee and Child(ren): $XX

Employee and Family: $XX

Kaiser HDHP

Employee Only: $XX

Employee and Spouse: $XX

Employee and Child(ren): $XX

Employee and Family: $XX

Kaiser HMO

Employee Only: $XX

Employee and Spouse: $XX

Employee and Child(ren): $XX

Employee and Family: $XX

MetLife Dental

Employee Only: $XX

Employee and Spouse: $XX

Employee and Child(ren): $XX

Employee and Family: $XX

MetLife Vision

Employee Only: $XX

Employee and Spouse: $XX

Employee and Child(ren): $XX

Employee and Family: $XX

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 Mainspring Energy if your domestic partner is your tax dependent.