(Effective January 1, 2025)
Your premiums and cost contributions are determined by several factors, including your elected benefits plans, the level of coverage you need, and who you choose to cover.
Keep in mind:
Unless otherwise indicated, the following plan year 2025 costs do not include any surcharges you and/or your covered spouse may incur.
Your premiums and cost contributions are determined by several factors, including your elected benefits plans, the level of coverage you need, and who you choose to cover.
Keep in mind:
- Medical, dental, and vision costs are deducted on a pre-tax basis each pay period.
- Costs for voluntary benefits, such as Supplemental Life and AD&D Insurance, Accident Insurance, Critical Illness Insurance, and the legal plan benefit will be deducted on an after-tax basis each pay period.
Unless otherwise indicated, the following plan year 2025 costs do not include any surcharges you and/or your covered spouse may incur.
Per pay period premiums for Hourly and Salaried employees are as follows.
Hourly Employees
| Coverage Tier | Green Plan | Blue Plan | Per Pay Period Premium (Weekly) | Per Pay Period Premium (Weekly) |
| Employee Only | $17.08 | $31.15 |
| Employee + Spouse | $49.38 | $78.00 |
| Employee + Child(ren) | $46.15 | $71.77 |
| Employee + Family | $72.46 | $119.08 |
Salaried Employees
| Coverage Tier | Green Plan | Blue Plan | Per Pay Period Premium (Semi-Monthly) | Per Pay Period Premium (Semi-Monthly) |
| Employee Only | $50.00 | $87.50 |
| Employee + Spouse | $133.50 | $210.00 |
| Employee + Child(ren) | $123.00 | $195.50 |
| Employee + Family | $191.00 | $300.50 |
Per pay period premiums for Hourly and Salaried employees are as follows.
Hourly Employees
| Coverage Tier | Per Pay Period Premium (Weekly) |
| Employee Only | $6.74 |
| Employee + Spouse | $13.77 |
| Employee + Child(ren) | $14.12 |
| Employee + Family | $22.83 |
Salaried Employees
| Coverage Tier | Per Pay Period Premium (Semi-Monthly) |
| Employee Only | $14.60 |
| Employee + Spouse | $29.84 |
| Employee + Child(ren) | $30.59 |
| Employee + Family | $49.46 |
Per pay period premiums for Hourly and Salaried employees are as follows.
Hourly Employees
| Coverage Tier | Per Pay Period Premium (Weekly) |
| Employee Only | $1.95 |
| Employee + Spouse | $2.83 |
| Employee + Child(ren) | $3.42 |
| Employee + Family | $5.15 |
Salaried Employees
| Coverage Tier | Per Pay Period Premium (Semi-Monthly) |
| Employee Only | $4.23 |
| Employee + Spouse | $6.14 |
| Employee + Child(ren) | $7.42 |
| Employee + Family | $11.16 |
The following monthly premiums apply to both Hourly and Salaried employees. To view pay period premiums, visit BenefitSource.
| Employee Age as of January 1, 2025 |
Monthly Premium Per $1,000 of Coverage |
| Under 30 | $0.085 |
| 30 – 34 | $0.105 |
| 35 – 39 | $0.115 |
| 40 – 44 | $0.145 |
| 45 – 49 | $0.215 |
| 50 – 54 | $0.325 |
| 55 – 59 | $0.595 |
| 60 – 64 | $0.915 |
| 65 – 69 | $1.755 |
| 70 – 74 | $2.805 |
| 75+ | $4.475 |
Per pay period premiums for Hourly and Salaried employees are as follows.
Hourly Employees
| Plan Option | Max Coverage Amount | Per Pay Period Premium(Weekly) |
| High | Spouse – $20,000
Per Child – $10,000 |
$1.57 |
| Low | Spouse – $10,000 Per Child – $5,000 |
$0.78 |
Salaried Employees
| Plan Option | Max Coverage Amount | Per Pay Period Premium(Semi-Monthly) |
| High | Spouse – $20,000
Per Child – $10,000 |
$3.40 |
| Low | Spouse – $10,000 Per Child – $5,000 |
$1.70 |
The following monthly premiums apply to both Hourly and Salaried employees. To view pay period premiums, visit BenefitSource.
Hourly Employees
| Plan Option | Monthly Premium Per $100 of Coverage |
| Long-Term Disability Rate | $0.610 |
Salaried Employees
| Plan Option | Monthly Premium Per $100 of Coverage |
| Long-Term Disability Rate | $0.515 |
Per pay period premiums for Hourly and Salaried employees are as follows.
Hourly Employees
| Coverage Tier | Per Pay Period Premium(Weekly) |
| Employee Only | $1.19 |
| Employee + Spouse | $2.02 |
| Employee + Child(ren) | $2.38 |
| Employee + Family | $3.21 |
Salaried Employees
| Coverage Tier | Per Pay Period Premium(Semi-Monthly) |
| Employee Only | $2.57 |
| Employee + Spouse | $4.38 |
| Employee + Child(ren) | $5.15 |
| Employee + Family | $6.96 |
The following monthly premiums apply to both Hourly and Salaried employees. To view pay period premiums, visit BenefitSource.
Employee and/or Spouse
| Employee/Spouse Age as of January 1, 2025 |
Employee Monthly Premium Per $1,000 of Coverage |
Spouse Monthly Premium Per $1,000 of Coverage |
| Under 25 | $0.54 | $0.54 |
| 25 – 29 | $0.56 | $0.56 |
| 30 – 34 | $0.58 | $0.58 |
| 35 – 39 | $0.64 | $0.64 |
| 40 – 44 | $0.83 | $0.83 |
| 45 – 49 | $1.15 | $1.15 |
| 50 – 54 | $1.66 | $1.66 |
| 55 – 59 | $2.44 | $2.44 |
| 60 – 64 | $3.18 | $3.18 |
| 65 – 69 | $3.92 | $3.92 |
| 70+ | $5.02 | $5.02 |
Child(ren) Coverage
| Child(ren) Coverage Amount (eligible up to age 26) |
Monthly Premium | |
| $2,500 | $1.63 | |
| $5,000 | $3.25 | |
| $10,000 | $6.50 | |
| $15,000 | $9.75 | |
Per pay period premiums for Hourly and Salaried employees are as follows.
Hourly Employee
| Plan Option | Per Pay Period Premium(Weekly) |
| LegalShield | $3.23 |
Salaried Employee
| Plan Option | Per Pay Period Premium(Semi-Monthly) |
| LegalShield | $7.00 |
If you are enrolled in the Lennox Green Medical Plan or Blue Medical Plan, you should complete these mandatory steps each year to maximize your health care savings:
Certify Working Spouse Status
A $100 monthly Working Spouse surcharge will apply if you enroll a working spouse who is offered health coverage through their employer. If this does not apply and you wish to avoid the surcharge, be sure to answer “No” on the Working Spouse Status question in BenefitSource during Open Enrollment every year. NOTE: If your status changes, call (800) 284-4549 and submit a Working Spouse Status affidavit.Confirm Tobacco Use
A $150 per person monthly Tobacco Use surcharge will apply if you and/or your covered spouse uses tobacco and enrolls in a Lennox medical plan. If this does not apply and you wish to avoid the surcharge, be sure to answer “No” on the Tobacco Use question in BenefitSource during Open Enrollment every year. NOTE: If you/your spouse’s status changes during the year, call (800) 284-4549 and submit a Tobacco Use affidavit.Complete an Annual Health Screening
A $75 per person monthly Wellness surcharge will apply if you and/or your covered spouse do not complete an annual health screening every year, and meet or improve 3 out of 5 measured health metrics by the next set deadline. To avoid this surcharge, visit LIIveWell for the latest information and deadlines. First time users will have to register. NOTE: In the case of a medical condition or pregnancy, a screening waiver can be submitted.Monthly Surcharge Overview
In the event that you do not comply with one or more of the above actions, you and/or your covered spouse will be charged the extra monthly surcharges as outlined below:| Monthly Surcharge | Employee | Covered Spouse |
| Working Spouse Status* | N/A | $100 |
| If Using Tobacco Products* | $150 | $150 |
| If You Fail to Complete an Annual Health Screening or Do Not Meet or Improve 3 of the 5 Measured Health Metrics** | $75 | $75 |
* If you or your covered spouse’s status changes during the year, you can submit an affidavit through BenefitSource.
** If you and/or your spouse complete a health screening but are unable to meet or improve 3 of the 5 measured health metrics due to a medical condition, your physician must complete and submit a Medical Waiver form.
** If you or your spouse are pregnant, you do NOT need to complete a health screening. Instead, you must complete and submit the Pregnancy Waiver form.
** If you and/or your spouse complete a health screening but are unable to meet or improve 3 of the 5 measured health metrics due to a medical condition, your physician must complete and submit a Medical Waiver form.
** If you or your spouse are pregnant, you do NOT need to complete a health screening. Instead, you must complete and submit the Pregnancy Waiver form.