Page 14 - 2016 Enrollment
P. 14
Beneits Guide
Employee Contributions
Bi-Weekly Rates
Medical
$3,000 $1,500 $1,500 $750
Deductible Deductible Deductible Deductible Dental Vision
Qualiied Qualiied Traditional Traditional
HDHP HDHP PPO PPO
Employee $19.86 $29.60 $55.90 $80.00 $4.98 $3.54
only (Ee)
Ee + $61.28 $90.29 $133.40 $202.15 $9.49 $5.67
spouse
Ee + $55.44 $81.70 $120.70 $168.14 $10.61 $5.78
child(ren)
Family $97.64 $138.55 $221.07 $309.71 $16.50 $9.33
Enrollment
Please contact a member of your Human Resources team with
any questions.
Katrina Mollenkopf
Phone: 614.322.3088
Fax: 614.864.5666
E-mail: kmollenkopf@capsasolutions.com
Kelsey Pack
Phone: 614.322.3041
Fax: 614.322.3580
E-mail: kpack@capsasolutions.com
The descriptions of the beneits are not guarantees of current or future
employment or beneits. If there is any conlict between this Guide and
the oficial Plan Documents, the oficial documents will govern.
14
Employee Contributions
Bi-Weekly Rates
Medical
$3,000 $1,500 $1,500 $750
Deductible Deductible Deductible Deductible Dental Vision
Qualiied Qualiied Traditional Traditional
HDHP HDHP PPO PPO
Employee $19.86 $29.60 $55.90 $80.00 $4.98 $3.54
only (Ee)
Ee + $61.28 $90.29 $133.40 $202.15 $9.49 $5.67
spouse
Ee + $55.44 $81.70 $120.70 $168.14 $10.61 $5.78
child(ren)
Family $97.64 $138.55 $221.07 $309.71 $16.50 $9.33
Enrollment
Please contact a member of your Human Resources team with
any questions.
Katrina Mollenkopf
Phone: 614.322.3088
Fax: 614.864.5666
E-mail: kmollenkopf@capsasolutions.com
Kelsey Pack
Phone: 614.322.3041
Fax: 614.322.3580
E-mail: kpack@capsasolutions.com
The descriptions of the beneits are not guarantees of current or future
employment or beneits. If there is any conlict between this Guide and
the oficial Plan Documents, the oficial documents will govern.
14
