Page 5 - 2020 BH Management Benefits Guide

2020 Employee Cost Summary

Medical Voluntary Life and

Administered by Wellmark Blue Cross Blue Shield. AD&D
Administered by The Hartford—
Traditional PPO Plan HDHP
Monthly Cost Per 24 Monthly Cost Per 24 employee pays 100% of the cost
Cost Pay Periods Cost Pay Periods of coverage.
Employee Only $159.24 $79.62 $148.32 $74.16
Employee and Spouse $431.97 $215.99 $402.17 $201.09 Short Term Disability
Employee and Child(ren) $399.48 $199.74 $371.94 $185.97 Company paid based on tenure,
Employee and Family $645.97 $322.99 $601.31 $300.66 option to purchase additional

Note: Rates do not include $50 spousal surcharge. coverage.

Dental Long Term Disability
Administered by Delta Dental. Administered by The Hartford—
employer-paid, no cost to
Coverage Tier Monthly Cost Cost Per 24 Pay Periods employee.
Employee Only $21.00 $10.50
Employee and Spouse $44.00 $22.00
Employee and Child $44.00 $22.00 EAP
Family $67.00 $33.50 Administered by ComPsych
through The Hartford—no cost to
employee.
Vision

Administered by Avesis. Voluntary Benefits—

Coverage Tier Monthly Cost Cost Per 24 Pay Periods Accident, Critical
Employee Only $6.03 $3.02 Illness, and Whole Life
Employee and Spouse $11.38 $5.69 Insurance
Employee and Child(ren) $11.82 $5.91 Administered by The Hartford—
Family $15.96 $7.98 employee pays 100% of
individually-rated policy.

Basic Life and AD&D

Administered by The Hartford—employer-paid, no cost to employee. Doctor on Demand
Available to medical plan
participants only—no cost to
employee.

2020 Benefits Guide 5