Page 16 - 2018 Capgemini Enrollment
P. 16
Medical Plan Semi-Monthly Employee Contributions Working spouse/domestic
partner contribution.
Premier Open Access Plus
If you enroll your spouse or domestic
Combined partner in Medical coverage through
Working Smoker & Capgemini, and he or she works and is
Spouse/ Working Spouse/ eligible for medical coverage through
Domestic Domestic his or her employer, you will be required
Coverage Type Non-Smoker* Smoker Partner Partner to pay a working spouse/domestic
partner medical contribution. This
You Only $45.05 $65.88 N/A N/A contribution will apply even if your
You + Spouse/ $97.55 $118.38 $118.38 $139.21 spouse or domestic partner has waived
Domestic Partner or declined participation in his or her
employer’s plan.
You + Child(ren) $84.03 $104.86 N/A N/A
Do you qualify for
You + Family $140.95 $161.78 $161.78 $182.61 non-smoker rates?
Check page 11 for more information.
Basic Open Access Plus
Combined
Working Smoker &
Spouse/ Working Spouse/
Domestic Domestic
Coverage Type Non-Smoker* Smoker Partner Partner
You Only $19.76 $40.59 N/A N/A
You + Spouse/ $44.44 $65.27 $65.27 $86.10
Domestic Partner
You + Child(ren) $38.51 $59.34 N/A N/A
You + Family $67.60 $88.43 $88.43 $109.26
Coverage levels can include any eligible dependents defined under the Benefits Eligibility section.
The rates shown do not apply to COBRA participants.
*Non-Smoker includes employees participating in the 2018 Smoking Cessation Program.
CAPGEMINI 2018 BENEFITS GUIDE 13
partner contribution.
Premier Open Access Plus
If you enroll your spouse or domestic
Combined partner in Medical coverage through
Working Smoker & Capgemini, and he or she works and is
Spouse/ Working Spouse/ eligible for medical coverage through
Domestic Domestic his or her employer, you will be required
Coverage Type Non-Smoker* Smoker Partner Partner to pay a working spouse/domestic
partner medical contribution. This
You Only $45.05 $65.88 N/A N/A contribution will apply even if your
You + Spouse/ $97.55 $118.38 $118.38 $139.21 spouse or domestic partner has waived
Domestic Partner or declined participation in his or her
employer’s plan.
You + Child(ren) $84.03 $104.86 N/A N/A
Do you qualify for
You + Family $140.95 $161.78 $161.78 $182.61 non-smoker rates?
Check page 11 for more information.
Basic Open Access Plus
Combined
Working Smoker &
Spouse/ Working Spouse/
Domestic Domestic
Coverage Type Non-Smoker* Smoker Partner Partner
You Only $19.76 $40.59 N/A N/A
You + Spouse/ $44.44 $65.27 $65.27 $86.10
Domestic Partner
You + Child(ren) $38.51 $59.34 N/A N/A
You + Family $67.60 $88.43 $88.43 $109.26
Coverage levels can include any eligible dependents defined under the Benefits Eligibility section.
The rates shown do not apply to COBRA participants.
*Non-Smoker includes employees participating in the 2018 Smoking Cessation Program.
CAPGEMINI 2018 BENEFITS GUIDE 13
