Page 4 - 11639_2019 Open EnrollmentGuidebook_interactive

2019 ASSOCIATE CONTRIBUTIONS
2019 – Associate Medical Contribution Tiers
Full Rate
**$25 Monthly Discount if You Completed Wellness Requirements in Oct / Nov 2018
Medical Plan
Monthly Associate Contributions
Plan Type
Tobacco Free Rate*
Gold
Associate Only
Silver
Associate Only
* To be eligible for the Tobacco Free Rate, your household must be tobacco and nicotine free.
** To be eligible for the Monthly Wellness Discount, you must have completed both the Biometric Screening AND the Health Risk Assessment
as communicated in October 2018 / November 2018. Medical contributions will be reduced by $12.50 per check, two pays per month per qualifying associate.
CHANGES FOR 2019 – Dental and Vision Monthly Contribution and Tier Changes
$273.00
$498.00
$131.00
$244.00
$171.00
Associate + Child(ren)
$305.00
Associate + Spouse
$760.00
$507.00
Family
$909.00
$555.00
$77.00
Associate + Child(ren)
$136.00
Associate + Spouse
$333.00
$200.00
Family
$428.00
$240.00
Bronze
Associate Only
$88.00
$48.00
Associate + Child(ren)
$191.00
$86.00
Associate + Spouse
$225.00
$124.00
Family
$335.00
$194.00
Dental Plan
Monthly Contributions
Basic Plan
Plus Plan
Associate Only
$22.78
$34.17
Associate + Child(ren)
$32.30
$75.90
Associate + Spouse
$30.02
$70.53
Associate + Family
$52.69
$123.82
Vision Plan
Monthly Contributions
VSP
UHC
Associate Only
$9.81
$4.74
Associate + Child(ren)
$16.60
$10.54
Associate + Spouse
$14.29
$8.99
Associate + Family
$25.62
$14.83
* Monthly contributions can be divided by 2 to get the amount of deduction per paycheck in a month (2 checks per month).
* In order to prevent loss of coverage, associates are responsible for payment of contributions missed while not receiving a paycheck
from the company.
4 Applied Choices – 2019
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