Page 35 - 2021 Dreyer's New Hire Guide

Employee Contributions

MEDICAL PLANS
EMPLOYEE
MONTHLY RATES EMPLOYER MONTHLY COST EMPLOYEE MONTHLY COST
PER-PAY-PERIOD COST*
ANTHEM BLUE CROSS MODIFIED CLASSIC HMO
Employee Only $630.91 $411.91 $219.00 $109.50
Employee + Spouse $1,388.01 $898.01 $490.00 $245.00
Employee + Child(ren) $1,135.64 $764.64 $371.00 $185.50
Family $1,955.83 $1,310.83 $645.00 $322.50
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KAISER HMO NORTHERN CALIFORNIA (NCA)
Employee Only $550.74 $411.49 $139.25 $69.63
Employee + Spouse $1,156.55 $897.55 $259.00 $129.50
Employee + Child(ren) $991.33 $764.58 $226.75 $113.38
Family $1,707.29 $1,310.79 $396.50 $198.25
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KAISER HMO SOUTHERN CALIFORNIA (SCA)
Employee Only $550.74 $444.74 $106.00 $53.00
Employee + Spouse $1,156.55 $969.30 $187.26 $93.63
Employee + Child(ren) $991.33 $841.33 $150.00 $75.00
Family $1,707.29 $1,468.29 $239.00 $119.50
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* Employee contributions to insurance are deducted from the first two paychecks of each month. For those months with a third
paycheck, no insurance premiums will be deducted from the third paycheck.

Note: Spousal surcharge of $90 per month applies if your spouse qualifies for coverage through their
employer’s plan.

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EMPLOYEE CONTRIBUTIONS