Page 11 - 2016 Enrollment

Bi-Weekly

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 $116.19 $113.88 $106.96 $104.65 N/A
Employee/
spouse $247.67 $245.36 $238.44 $236.13 $224.59
Employee/ $194.83 $192.52 $185.60 $183.29 N/A
child(ren)
Family $321.34 $319.03 $312.11 $309.80 $298.26
High Deductible Plan
Employee $56.19 $53.88 $46.96 $44.65 N/A
Employee/
spouse $129.28 $126.97 $120.05 $117.74 $106.20
Employee/
child(ren) $89.91 $87.60 $80.68 $78.37 N/A
Family $151.71 $149.40 $142.48 $140.17 $128.63

Medical 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

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

Dental Plan
Bi-Weekly Employee Contributions
Employee $11.81
Employee/spouse $26.61
Employee/child(ren) $25.44
Family $41.75

Vision Plan
Bi-Weekly Employee Contributions
Employee $5.11
Employee/spouse $8.61
Employee/child(ren) $8.79
Family $14.16

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