CODAC 2024 Guide To Your Benefits
EMPLOYEE RESPONSIBILITY CALCULATOR Use the tool below to calculate your per pay period out-of-pocket cost
PRE-TAX BENEFITS
______ MEDICAL: Medical Plan and identify coverage level. Enter per paycheck cost.
A
______ HSA: Choose Health Saving Account Contribution. Enter per paycheck cost.
+B
______ DENTAL: Choose Dental Plan and identify coverage level. Enter per paycheck cost.
+C
______ VISION: Identify coverage level. Enter per paycheck cost.
+D
______ FSA MEDICAL: Enter your per pay period contribution.
+E
______ FSA LIMITED PURPOSE: Enter your per pay period contribution (must be enrolled in Choice Plus Plan).
+F
______ FSA DEPENDENT CARE: Enter your per pay period contribution.
+G
______ AFLAC ACCIDENT: Cost provided by AFLAC Representative. Enter per pay period cost.
+H
______ AFLAC CANCER: Cost provided by AFLAC Representative. Enter per pay period cost.
+I
______ AFLAC HOSPITAL: Cost provided by AFLAC Representative. Enter per pay period cost.
+J
- $112.50 CAFETERIA ALLOWANCE PER PAY PERIOD
______ EE PRE-TAX RESPONSIBILITY: This is the amount you are responsible for pre-tax out of pocket each pay period. Note: There are 26 pay periods.
=K
POST TAX BENEFITS
______ VOLUNTARY LIFE: See per pay period amount provided in Employee Access.
A
______ VOLUNTARY STD: See per pay period amount provided in Employee Access.
+B
______ 529 COLLEGE PLAN
+C
______ PET INSURANCE
+D
______ ROTH 403(b)
+E
______ EE POST-TAX RESPONSIBILITY: This is the amount you are responsible for post-tax out-of-pocket each pay period. Note: There are 26 pay periods. ______ TOTAL EE RESPONSIBILITY: This is the TOTAL amount you are responsible for your benefit selections out-of-pocket each pay period. Note: There are 26 pay periods.
=F
K+F
14 CODAC Health, Recovery & Wellness | 2024 Employee Benefits Guide
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