Rates and fees
Monthly medical/dental and vision costs
| Employee only | Employee + child(ren)/domestic partner child(ren) | Employee + spouse/domestic partner | Employee + family | |
| Medical* | ||||
| GeoBlue CDHP + HSA + Dental | $69.65 | $171.30 | $194.01 | $287.65 |
| GeoBlue PPO + Dental | $141.66 | $308.08 | $345.21 | $514.56 |
| Vision | ||||
| $6.97 | $13.94 | $13.24 | $20.49 | |
Fees
Schneider Electric self-insures its medical plan options. This means after you pay your share of the cost for coverage and services, the Company pays the remaining cost of medical claims for you and your family. As a participant in our plans, you have a direct impact on the overall cost of medical expenses. In an effort to help contain these costs, the following fees may apply depending on your responses (or lack of response) during your benefit enrollment:*
- Health evaluation non-participation monthly fee: $50 per person
- Tobacco-user monthly fee: $50
- Working spouse/domestic partner monthly fee: $75
* If you’re a current employee and you don’t change your response during Annual Enrollment, your responses will automatically carry forward to the next calendar year.
Life and AD&D monthly costs
Basic Life Insurance — imputed income
If your Basic Life Insurance coverage is more than $50,000, you will owe taxes on the value of your coverage over $50,000. This value is called imputed income. IRS regulations require the Company to report employee federal wages and deduct Social Security taxes (FICA) on imputed income from your paycheck and report it on your W-2 each year.
Under IRS regulations, imputed income is based on your age and the monthly cost per $1,000 of life insurance over $50,000. To determine your monthly amount of imputed income, multiply the rate in the following IRS table by the amount of your insurance coverage over $50,000 divided by $1,000.
| IRS Table — Monthly cost of $1,000 of insurance | |
| Employee’s age | IRS rate |
| Under 25 | $0.05 |
| 25 – 29 | $0.06 |
| 30 – 34 | $0.08 |
| 35 – 39 | $0.09 |
| 40 – 44 | $0.10 |
| 45 – 49 | $0.15 |
| 50 – 54 | $0.23 |
| 55 – 59 | $0.43 |
| 60 – 64 | $0.66 |
| 65 – 69 | $1.27 |
| 70 and over | $2.06 |
Imputed income example
Supplemental AD&D Insurance
The monthly rate for Supplemental AD&D Insurance is $0.019 for every $1,000 of coverage you elect.
Supplemental Life and Spouse Life Insurance
Monthly rate per $1,000 of coverage:
| Employee/spouse age | Employee rates | Spouse rates | ||
| Non tobacco-user rate | Tobacco-user rate | Non tobacco-user rate | Tobacco-user rate | |
| Under 25 | $0.026 | $0.039 | $0.027 | $0.040 |
| 25 – 29 | $0.031 | $0.047 | $0.036 | $0.053 |
| 30 – 34 | $0.042 | $0.062 | $0.045 | $0.067 |
| 35 – 39 | $0.046 | $0.074 | $0.052 | $0.084 |
| 40 – 44 | $0.049 | $0.087 | $0.067 | $0.118 |
| 45 – 49 | $0.081 | $0.132 | $0.109 | $0.191 |
| 50 – 54 | $0.123 | $0.203 | $0.162 | $0.312 |
| 55 – 59 | $0.217 | $0.360 | $0.258 | $0.429 |
| 60 – 64 | $0.360 | $0.561 | $0.440 | $0.685 |
| 65 – 69 | $0.662 | $0.985 | $0.757 | $1.122 |
| 70 and over | $1.206 | $1.815 | $1.800 | $2.600 |
Child Life Insurance
| Coverage level | Weekly cost | Semi-monthly cost |
| $5,000 | $0.10 | $0.23 |
| $10,000 | $0.21 | $0.45 |
Disability monthly costs
Short-term disability
| Your options | STD coverage levels | Cost per $100 of monthly base pay |
| Company-paid | 100% of your base pay for 4 weeks, 60% of your base pay thereafter | $0.00 |
| Buy-up* | 100% of your base pay for 4 weeks, 70% of your base pay thereafter | $0.035 |
* Due to state law, employees who work in New Jersey will automatically receive the STD Buy-up coverage level Company-paid. If you work in New Jersey, your option will be reflected on
Long-term disability
| Your options | LTD coverage levels | Cost per $100 of monthly base pay |
| Company-paid | 50% of your base pay | $0.00 |
| Buy-up | 60% of your base pay | $0.105 |
Legal services plan
The cost for coverage is $16.50 per month.