Medical Bi-Weekly Contribution Rates
| Base HSA Plan (HDHP) | Buy-up HSA Plan (HDHP) | Choice Plus Copay Plan (PPO) | Kaiser (HMO) CA Only | |
|---|---|---|---|---|
| Base HSA Plan (HDHP) | Buy-up HSA Plan (HDHP) | Choice Plus Copay Plan (PPO) | Kaiser (HMO) CA Only | |
| You only | $14.52 | $26.62 | $38.73 | $35.09 |
| You + Spouse | $25.41 | $38.72 | $67.76 | $66.55 |
| You + Child(ren) | $24.20 | $33.88 | $66.55 | $58.08 |
| You + Family | $27.83 | $50.82 | $93.17 | $104.06 |
The above medical rates don’t reflect the tobacco-user surcharge. If you or your spouse/domestic partner identify as using tobacco, a surcharge will be added to your bi-weekly medical premiums. This is a $20 surcharge for one tobacco user and $40 for two.
Learn how to get the surcharge waived by completing the Quit for Life Program.
Dental Bi-Weekly Contribution Rates
| BCBSTX PPO Base Plan | BCBSTX PPO Buy-up Plan | |
|---|---|---|
| You only | $0.00 | $6.04 |
| You + Spouse | $3.64 | $18.15 |
| You + Child(ren) | $3.63 | $14.52 |
| You + Family | $6.05 | $25.41 |
Vision Bi-Weekly Contribution Rates
| VSP Base Plan | VSP Buy-up Plan | |
|---|---|---|
| You only | $0.00 | $6.05 |
| You + Spouse | $1.21 | $17.13 |
| You + Child(ren) | $1.21 | $11.63 |
| You + Family | $2.42 | $24.00 |
Contact
MySamsungBenefits
- MySamsungBenefits.com
- 1-833-420-1019 (7 a.m. – 7 p.m. CT, Monday – Friday)
- help@mybenefitexpress.com
Locate in microsite here: https://yoursamsungbenefits.com/enrollment/rates/