CODAC 2025 Emplyee Benefits Guide

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

+G

______ FSA DEPENDENT CARE: Enter your per pay period contribution.

+H

______ AFLAC ACCIDENT: Cost provided by AFLAC Representative. Enter per pay period cost.

+ I

______ AFLAC CANCER: Cost provided by AFLAC Representative. Enter per pay period cost.

+J

______ AFLAC HOSPITAL: Cost provided by AFLAC Representative. Enter per pay period cost.

- $112.50 CAFETERIA ALLOWANCE PER PAY PERIOD

=K

______ 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.

POST TAX BENEFITS

A

______ VOLUNTARY LIFE: See per pay period amount provided in Employee Access.

+B

______ VOLUNTARY STD: See per pay period amount provided in Employee Access.

+C

______ 529 COLLEGE PLAN

+D

______ PET INSURANCE

+E

______ ROTH 403(b)

=F

______ 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.

K+F

CODAC Health, Recovery & Wellness | 2025 Employee Benefits Guide 15