Page 6 - 2019 Sharks Benefits V6.1

Benefit Plan Contributions

Plan Type Semi-Monthly Deduction (Pre-Tax)

Medical
Anthem PPO (for CA employees)
Employee $105.42
Employee + One $221.40
Employee + Two or More $316.29
Anthem BlueCard PPO (For non-CA employees)
Employee $ 93.26
Employee + One $195.85
Employee + Two or More $279.78
Anthem Blue Cross HMO
Employee $ 88.43
Employee + One $185.70
Employee + Two or More $265.28
Kaiser HMO (Medical Only)
Employee $ 66.57
Employee + One $139.80
Employee + Two or More $199.71
Kaiser HMO (Medical with Vision Included)
Employee $ 67.59
Employee + One $141.93
Employee + Two or More $202.76
Dental

Delta Dental PPO
Employee $ 8.17
Employee + One $16.16
Employee + Children $20.67
Employee + Family $28.83

Delta Dental DHMO
Employee $ 2.28
Employee + One $ 4.23
Employee + Children $ 4.30
Employee + Family $ 6.20

Beam Dental DHMO
Employee $ 7.60
Employee + One $15.20
Employee + Children $18.00
Employee + Family $27.94
Stand-Alone Vision

Anthem Blue View
Employee $ 1.21
Employee + One $ 1.93
Employee + Family $ 3.14
These rates are effective January 1, 2019.
3