Your Medical Benefits

Medical/Rx Benefit Summaries – 4/1/2024-3/31/2025
Summary of Benefits & Coverage (SBC) – 4/1/2024-3/31/2025
Contribution Schedule

Rates effective 4/1/2024-3/31/2025

Medical/Rx
Virtual PlusTotal PremiumTutta Bella PaysYou Pay
Employee Only$439.14$240.14$199.00
Employee + Spouse/DP*$1,146.11$240.14$905.97
Employee + Child(ren)$834.36$240.14$594.22
Employee + Family$1,541.33$240.14$1,301.19
Medical/Rx
Access PPOTotal PremiumTutta Bella PaysYou Pay
Employee Only$552.86$240.14$312.72
Employee + Spouse/DP*$1,442.90$240.14$1,202.76
Employee + Child(ren)$1,050.43$240.14$810.29
Employee + Family$1,940.48$240.14$1,700.34
Helpful Resources

Kaiser Permanente
Customer Service: (888) 297-6877
www.kp.org/wa

Virtual Plus Group #: 2198100
Access PPO Group #: 8519300

Network: Virtual Plus – Connect and Access PPO

Your Voluntary Dental Benefits

Contribution Schedule

Rates effective 4/1/2024-3/31/2025

Voluntary Dental
Total PremiumYou Pay
Employee Only$33.34$33.34
Employee + Spouse$65.15$65.15
Employee + Child(ren)$86.10$86.10
Employee + Family$124.24$124.24
Helpful Resources

Principal 
Customer Service: (800) 986.3343
www.principal.com
Group Number: 1108713
Network: PPO

Your Voluntary Vision Benefits

Contribution Schedule

Rates effective 4/1/2024-3/31/2025

Voluntary Vision
Total PremiumYou Pay
Employee Only$5.31$5.31
Employee + Spouse$11.19$11.19
Employee + Child(ren)$11.96$11.96
Employee + Family$19.16$19.16
Helpful Resources

VSP (through Principal)
Customer Service: (800) 877-7195
www.vsp.com

Group # 910983

Network: VSP Choice

Your Life/AD&D Benefits

Contribution Schedule

Rates effective 4/1/2024-3/31/2025

Life
Total PremiumYou Pay
Employee$2.97$1.48
Helpful Resources

Principal
Phone: (800) 986-3343
www.principal.com

Group # 1108713