Page 10 - 2016 Enrollment

Employee Contributions

Semi-Monthly

Below are the employee contributions for the medical, dental, and vision.

Medical Plans
Targeted Risk Fully Engaged Fully Engaged
Premium Core Program Program (1 Participant) (2 Participants)
Traditional Plan
Employee $125.88 $123.88 $115.88 $113.38 N/A
Employee/spouse $268.31 $265.81 $258.31 $255.81 $243.31
Employee/ $211.07 $208.57 $201.07 $198.57 N/A
child(ren)
Family $348.12 $345.62 $338.12 $335.62 $323.12
High Deductible Plan
Employee $60.87 $58.37 $50.87 $48.37 N/A
Employee/spouse $140.05 $137.55 $130.05 $127.55 $115.05
Employee/ $97.40 $94.90 $87.40 $84.90 N/A
child(ren)
Family $164.36 $161.86 $154.36 $151.86 $139.36

Medical Plan Contribution Explanation
X Participation in the Core Program = $60 in savings annually

X Participation in the Targeted Risk Program = $240 in savings annually
X Fully Engaged (participation in both programs) = $300 in savings annually
for one participant (employee, spouse, or domestic partner); $600 in savings
annually for two participants

Additional information on the program with EngagementHealth can be found
in the wellness guide

Dental Plan
Semi-Monthly Employee Contributions
Employee $12.80
Employee/spouse $28.83
Employee/child(ren) $27.56
Family $45.23

Vision Plan
Semi-Monthly Employee Contributions
Employee $5.54
Employee/spouse $9.52
Employee/child(ren) $9.33
Family $15.35

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2016 New Hire Benefits Guide