Page 4 - Demo IPC benefits flip

Indiana Packers realizes the importance of giving our team members flexible options when it comes to healthcare. Rates for three separate healthcare plans are outlined below, as well as two dental and vision options. Please see the Team Member Benefits Overview Brochure for medical, dental and vision coverage.
EMPLOYEE CONTRIBUTIONS
Medical Plan Options
Medical and Rx is effective 2.1.2020. Coverage details can be found on the back of this insert, as well as the Team Member Benefits Overview Brochure *Certain restrictions apply; see your benefits department for details **Rates subject to change on an annual basis
Bi-Weekly Paid Employees must double the weekly contribution for their cost calculation. See your local Benefits Specialist for more information.
Dental Plan Options
Dental is effective 1.1.2020. Coverage details can be found in the Team Member Benefits Overview Brochure. Vision Plan Options
Medical Insurance (UMR)
PREMIER-PLAN A
VALUE-PLAN B
CDHP-PLAN C
Weekly
Bi-Weekly
Weekly
Bi-Weekly
Weekly
Bi-Weekly
Employee**
$16.83
$33.66
$15.75
$31.50
$10.16
$20.32
Employee + 1**
$50.97
$101.94
$32.80
$65.60
$21.14
$42.28
Family (Employee+2 or more)**
$69.06
$138.12
$54.24
$108.48
$34.95
$69.90
Dental Insurance (Delta Dental)
PREMIER-PLAN A
VALUE-PLAN B
Weekly
Bi-Weekly
Weekly
Bi-Weekly
EE Single
$4.46
$8.92
$2.51
$5.02
EE+1 (Employee + 1)
$7.13
$14.26
$4.03
$8.06
EE+2 or more (Employee+2 or more)
$13.49
$26.98
$8.39
$16.78
Vision Insurance (VSP)
PREMIER-PLAN A
VALUE-PLAN B
Weekly
Bi-Weekly
Weekly
Bi-Weekly
EE Single
$2.28
$4.56
$1.14
$2.28
EE+1 (Employee + 1)
$4.56
$9.12
$2.28
$4.56
EE+2 or more (Employee+2 or more)
$7.34
$14.68
$3.67
$7.34
Vision is effective 1.1.2020. Coverage details can be found in the Team Member Benefits Overview Brochure.
MEDICAL COVERAGE QUESTIONS : 616.399.3330 | benefits@quincystreetinc.com
RATE CARD
| QSI | 2020