Domestic Partner Monthly Imputed Income 2017

Visas cost of providing health care coverage for your domestic partner and his or her eligible children is taxable income imputed to you for federal
income tax purposes unless the covered individual is your dependent as defined by Section 152 of the Internal Revenue Code.
In general, for federal income tax purposes, your domestic partner, or your domestic partners child, is your dependent in any calendar year if he
or she: (1) is a member of your household for the year and his or her principal place of abode for the year is in your home, and (2) receives over
half of his or her support for the year from you. Support includes food, shelter, clothing, medical and dental care, and education.
Even if the covered individual is not your dependent for federal income tax purposes, if you are a resident of California and your domestic
partnership is registered in California, Visas cost of providing health care coverage for your domestic partner and his or her eligible children is not
taxable income to you for state income tax purposes, and if you are a resident of another state, may not be taxable income to you under that
states laws. Contact your tax advisor for more information.
The numbers below represent the monthly amount of Visas cost that may be subject to federal and state income tax in 2017 on the coverage
selected.

Medical
Cigna Choice Cigna POS Cigna OAP Cigna Utah PPO Kaiser Kaiser Kaiser
Fund Plan Permanente Permanente Permanente
(N. California) (Colorado) (Mid-Atlantic)

Employee +
domestic
partner $769.63
(under $50K)
or
$672.37 $798.04 $653.76 $536.75 $580.88 $520.13
Employee +
domestic $739.30
partner + (over $50K)
employees
child
 Cigna Choice Cigna POS Cigna OAP Cigna Utah PPO Kaiser Kaiser Kaiser
Fund Plan Permanente Permanente Permanente
(N. California) (Colorado) (Mid-Atlantic)

Employee + $589.28
domestic (under $50K)
partners child $488.99 $580.40 $475.48 $390.47 $422.41 $378.31
$567.23
(over $50K)

Employee + $1,250.58
domestic (under $50K)
partner + $1,161.34 $1,378.44 $1,129.24 $927.36 $1,003.29 $898.49
domestic $1,198.18
partners child (over $50K)

Dental, Vision and International

Cigna Comprehensive Cigna Dental HMO VSP Base Vision VSP Premier Vision Cigna International
Dental PPO Plan Plan Plan Plan Medical, Dental & Vision

Employee + domestic
partner
or $68.34 $29.02 $9.33 $22.62 $1,393.21
Employee + domestic
partner + employees child

Employee + domestic
$49.70 $21.10 $6.78 $16.44 $935.74
partners child

Employee + domestic
partner + domestic $118.02 $50.15 $16.11 $39.06 $1,891.00
partners child