All Employees (except Hawaii)

Bi-Weekly Employee Costs for Medical, Dental and Vision Plans (No Domestic Partner Enrolled)

Plan Year: Jan 1, 2019 – Dec 31, 2019

columns scroll horizontally for more info

Coverage Election Medical
  Health Reimbursement Account (HRA) Exclusive Provider Organization (EPO) Health Savings Plan (HSA)
  Employee Employer Employee Employer Employee Employer
Employee Only $24.00 $204.72 $44.00 $215.09 $34.00 $191.53
Employee plus Spouse $60.00 $397.46 $99.00 $419.18 $78.00 $373.08
Employee plus Children $46.00 $366.82 $81.00 $385.35 $64.00 $343.56
Employee plus Family $80.00 $600.58 $138.00 $639.24 $106.00 $562.62
Additional Working Partner Premium1 $46.15   $46.15   $46.15  
Coverage Election Dental Vision
  PPO Network Open Network
  Employee Employer Employee Employer Employee Employer
Employee Only $4.00 $8.99 $15.00 $8.99 $3.00 $0.00
Employee plus Spouse $8.00 $16.03 $27.00 $16.03 $5.00 $0.00
Employee plus Children $10.00 $18.57 $33.00 $18.57 $5.00 $0.00
Employee plus Family $14.00 $25.61 $46.00 $25.61 $8.00 $0.00

Working spouse premium is in addition to the premium shown above.

Domestic Partner2 Enrolled: Bi-Weekly Pre-Tax vs Post-Tax Costs for Medical, Dental and Vision Plans

Plan Year: Jan 1, 2019 – Dec 31, 2019

columns scroll horizontally for more info

Coverage Election Medical
  Health Reimbursement Account (HRA) Exclusive Provider Organization (EPO) Health Savings Plan (HSA)
  Pre-Tax Post-Tax Pre-Tax Post-Tax Pre-Tax Post-Tax
Employee plus DP $24.00 $36.00 $44.00 $55.00 $34.00 $44.00
Employee plus Children
(where only DP children are covered)
$24.00 $22.00 $44.00 $37.00 $34.00 $30.00
Employee Plus Family
(where DP and at least one non-DP child are covered)
$44.00 $36.00 $83.00 $55.00 $62.00 $44.00
Employee Plus Family
(where DP and only DP child(ren) are covered)
$22.00 $58.00 $46.00 $92.00 $32.00 $74.00
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$58.00 $22.00 $101.00 $37.00 $76.00 $30.00
Coverage Election Dental Vision
  PPO Network Open Network
  Pre-Tax Post-Tax Pre-Tax Post-Tax Pre-Tax Post-Tax
Employee plus DP $4.00 $4.00 $15.00 $12.00 $3.00 $2.00
Employee plus Children
(where only DP children are covered)
$4.00 $6.00 $15.00 $18.00 $3.00 $2.00
Employee Plus Family
(where DP and at least one non-DP child are covered)
$10.00 $4.00 $34.00 $12.00 $6.00 $2.00
Employee Plus Family
(where DP and only DP child(ren) are covered)
$4.00 $10.00 $16.00 $30.00 $4.00 $4.00
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$8.00 $6.00 $28.00 $18.00 $6.00 $2.00

Domestic Partner3 Enrolled: Bi-Weekly Imputed Income

Plan Year: Jan 1, 2019 – Dec 31, 2019

Coverage Election Medical
  Health Reimbursement Account (HRA) Exclusive Provider Organization (EPO) Health Savings Plan (HSA)
Employee plus DP $192.73 $204.09 $181.54
Employee plus Children
(where only DP children are covered)
$162.10 $170.26 $152.03
Employee Plus Family
(where DP and at least one non-DP child are covered)
$192.73 $204.09 $181.54
Employee Plus Family
(where DP and only DP child(ren) are covered)
$393.86 $426.16 $369.09
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$162.10 $170.26 $152.03
Coverage Election Dental Vision
  PPO Network Open Network
Employee plus DP $7.04 $7.87 $0.00
Employee plus Children
(where only DP children are covered)
$9.59 $10.05 $0.00
Employee Plus Family
(where DP and at least one non-DP child are covered)
$7.04 $7.87 $0.00
Employee Plus Family
(where DP and only DP child(ren) are covered)
$16.63 $17.92 $0.00
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$9.59 $10.05 $0.00

1You’ll pay an additional working partner premium of $46.15 per pay period if you’re covering a spouse or domestic partner who chooses not to be covered through their employer as primary coverage.

2You are responsible for paying both the pre-tax and the post-tax portion of the contribution.

3This represents the amount that T-Mobile pays for your domestic partner’s coverage. Because the IRS doesn’t consider them to be a tax dependent, this amount is added to your paycheck as taxable income.

Hawaii

HMSA Bi-Weekly Costs for Medical, Dental and Vision Plans (No Domestic Partner Enrolled)

Plan Year: Jan 1, 2019 – Dec 31, 2019

columns scroll horizontally for more info

Coverage Election Medical
  HMSA HMO HMSA PPO
  Employee Employer Employee Employer
Employee Only $6.00 $198.47 $6.00 $202.82
Employee plus Spouse $74.00 $393.80 $99.00 $378.76
Employee plus Children $54.00 $333.89 $84.00 $312.15
Employee plus Family $96.00 $555.82 $136.00 $529.70
Additional Working Partner Premium1 $46.15   $46.15  
Coverage Election Dental Vision
  PPO Network Open Network
  Employee Employer Employee Employer Employee Employer
Employee Only $4.00 $8.99 $15.00 $8.99 $3.00 $0.00
Employee plus Spouse $8.00 $16.03 $27.00 $16.03 $5.00 $0.00
Employee plus Children $10.00 $18.57 $33.00 $18.57 $5.00 $0.00
Employee plus Family $14.00 $25.61 $46.00 $25.61 $8.00 $0.00

HMSA Bi-Weekly Pre-Tax vs Post-Tax Contributions for Medical, Dental and Vision Plans with Domestic Partner2 Enrolled

Plan Year: Jan 1, 2019 – Dec 31, 2019

Coverage Election Medical
  HMSA HMO HMSA PPO
  Pre-Tax Post-Tax Pre-Tax Post-Tax
Employee plus DP $6.00 $68.00 $6.00 $93.00
Employee plus Children
(where only DP children are covered)
$6.00 $48.00 $6.00 $78.00
Employee Plus Family
(where DP and at least one non-DP child are covered)
$28.00 $68.00 $43.00 $93.00
Employee Plus Family
(where DP and only DP child(ren) are covered)
$0.00 $96.00 $0.00 $136.00
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$48.00 $48.00 $58.00 $78.00
Coverage Election Dental Vision
  PPO Network Open Network
  Pre-Tax Post-Tax Pre-Tax Post-Tax Pre-Tax Post-Tax
Employee plus DP $4.00 $4.00 $15.00 $12.00 $3.00 $2.00
Employee plus Children
(where only DP children are covered)
$4.00 $6.00 $15.00 $18.00 $3.00 $2.00
Employee Plus Family
(where DP and at least one non-DP child are covered)
$10.00 $4.00 $34.00 $12.00 $6.00 $2.00
Employee Plus Family
(where DP and only DP child(ren) are covered)
$4.00 $10.00 $16.00 $30.00 $4.00 $4.00
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$8.00 $6.00 $28.00 $18.00 $6.00 $2.00

HMSA Bi-Weekly Imputed Income

Plan Year: Jan 1, 2019 – Dec 31, 2019 with Domestic Partner3 Enrolled

Coverage Election Medical
  HMSA HMO HMSA PPO
Employee plus DP $195.33 $175.94
Employee plus Children
(where only DP children are covered)
$135.42 $109.33
Employee Plus Family
(where DP and at least one non-DP child are covered)
$195.33 $175.94
Employee Plus Family
(where DP and only DP child(ren) are covered)
$351.35 $320.88
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$135.42 $109.33
Coverage Election Dental Vision
  PPO Network Open Network
Employee plus DP $7.04 $7.87 $0.00
Employee plus Children
(where only DP children are covered)
$9.59 $10.05 $0.00
Employee Plus Family
(where DP and at least one non-DP child are covered)
$7.04 $7.87 $0.00
Employee Plus Family
(where DP and only DP child(ren) are covered)
$16.63 $17.92 $0.00
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$9.59 $10.05 $0.00

1You’ll pay an additional working partner premium of $46.15 per pay period if you’re covering a spouse or domestic partner who chooses not to be covered through their employer as primary coverage.

2You are responsible for paying both the pre-tax and the post-tax portion of the contribution

3This represents the amount that T-Mobile pays for your domestic partner’s coverage. Because the IRS doesn’t consider them to be a tax dependent, this amount is added to your paycheck as taxable income