Worksheet to Calculate Taxable Income
If a same-sex domestic partner and/or children do not meet the definition of a qualified tax
dependent, the company is required to add the value of the medical care and/or dental care
coverage for these individuals to the employee’s income. Use this worksheet, including the
Value of Coverage Estimating Tables on the following page, to estimate your taxable income.
An employee’s total cost for same-sex domestic partner coverage will include the taxes they pay
on the taxable income calculated below, health care and dental care option contribution amounts,
and additional contributions or surcharges if applicable.
Please refer to the Enrollment Package — GE SSDP Eligibility for GE Health Care and Dental
Care Options on benefits.ge.com.
Value of Coverage Amount
1. Enter the value of coverage amount for the medical care option you are enrolled in.
Refer to the Value of Coverage Estimating Tables and enter a value from Section A, B or C. ___________________________
2. Enter the value of coverage amount for the dental care option you are enrolled in.
Refer to the Value of Coverage Estimating Tables and enter a value from Section D or E. ___________________________
3. Refer to the Value of Coverage Estimating Tables and enter a value from Section F
if applicable (if not enrolling in Vision Plus option, enter zero). ___________________________
4. Add the amounts on Lines 1,2, and 3 above. This is the total estimated value for the
medical care, vision and dental care coverage. ___________________________
Qualified Dependent Ratio
5. Enter the number of non-qualified tax dependents you will be covering. Refer to page 4
for a definition of qualified tax dependents. If your dependents do not meet this definition,
they are non-qualified tax dependents. ___________________________
Please note: your same-sex domestic partner may also be a non-qualified tax dependent.
6. Enter the total number of dependents (qualified and nonqualified) including yourself. ___________________________
7. Divide the amount on Line 5 by the amount on Line 6.
If this value is < 33.34%, use 25%
If this value is > 33.34%, but less than 66.67%, use 50%
If this value is > 66.67%, use 75%
Enter the rounded value on Line 6 ___________________________
Annual Taxable Income Estimate
8. Multiply the value of line 4 and Line 7.
This is the annual value of coverage that is subject to tax and will be reflected in your
paycheck on a monthly basis.
Value of Coverage Estimating Tables
Please note: The starting point for calculating the taxable income impact of covering a same-sex domestic partner
and/or children is:
• Two Person Coverage – if the coverage is for the employee and the same-sex domestic partner only.
• Three or More Coverage – if eligible children are covered in addition to the employee and the same-sex domestic partner.
Annual Value of Coverage Amount
Two Person Three or More
A. GE Health Choice Option 1 $11,095.14 $16,642.20
B. GE Health Choice Option 2 $10,430.27 $15,644.89
C. GE Health Choice Option 3 $9,047.85 $13,571.53
D. GE Dental Schedule Option $584.06 $876.10
E. GE Dental Premium Option $1,070.44 $1,605.91
F. GE Vision Plus Option $188.21 $282.31