Page 10 - First Bank- Open Enrollment Guide 2015
P. 10
Open
Enrollment
Employee
Contribution 2015 Employee Contributions (semi-monthly)
Rates Medical/Prescription
Anthem Blue Cross Blue Shield Option A
Employee $70.00
Employee + Spouse $197.00
Employee + Child (ren) $167.00
Employee + Family $275.00
Anthem Blue Cross Blue Shield Option B
Employee $47.00
Employee + Spouse $139.00
Employee + Child (ren) $120.00
Employee + Family $198.00
Kaiser Permanente HMO(California residents Only)
Employee $68.00
Employee + Spouse $190.00
Employee + Child (ren) $161.00
Employee + Family $266.00
Dental
Delta Dental PPO Plans Option A
Employee $18.78
Employee + Spouse $34.32
Employee + Child (ren) $51.56
Employee + Family $69.81
Delta Dental PPO Plans Option B
Employee $7.92
Employee + Spouse $17.00
Employee + Child (ren) $28.45
Employee + Family $39.89
10
Enrollment
Employee
Contribution 2015 Employee Contributions (semi-monthly)
Rates Medical/Prescription
Anthem Blue Cross Blue Shield Option A
Employee $70.00
Employee + Spouse $197.00
Employee + Child (ren) $167.00
Employee + Family $275.00
Anthem Blue Cross Blue Shield Option B
Employee $47.00
Employee + Spouse $139.00
Employee + Child (ren) $120.00
Employee + Family $198.00
Kaiser Permanente HMO(California residents Only)
Employee $68.00
Employee + Spouse $190.00
Employee + Child (ren) $161.00
Employee + Family $266.00
Dental
Delta Dental PPO Plans Option A
Employee $18.78
Employee + Spouse $34.32
Employee + Child (ren) $51.56
Employee + Family $69.81
Delta Dental PPO Plans Option B
Employee $7.92
Employee + Spouse $17.00
Employee + Child (ren) $28.45
Employee + Family $39.89
10
