Page 26 - QSC Benefits Guide 7-17 REMOTE

YOUR COST FOR COVERAGE - PER PAYCHECK

This chart compares the per paycheck contributions for our Employee Benefit plans. Your cost for coverage will vary depending
on the options and level of coverage you choose.

Vision - EyeMed Voluntary Pet Health Care Program - United
Pet Care (Preferred Program / Partner)
Employee Only $2.00
Employee + Spouse $3.00 One Pet $4.89
Employee + Child(ren) $4.00 Two Pets $9.32
Employee + Family $5.00 Three Pets $13.66
Each Additional Pet $4.29
Dental Option 1 - PPO - Cigna
Employee Only $10.00 Voluntary Pet Health Care Program - United
Pet Care (Select Program)
Employee + Spouse $15.00
One Pet $4.04
Employee + Child(ren) $14.00
Two Pets $7.66
Employee + Family $25.00
Three Pets $11.22
Each Additional Pet $3.55
Dental Option 2 - Premier PPO - Cigna
Employee Only $20.00
Employee + Spouse $30.00 Voluntary Pet Health Care Program -
Nationwide
Employee + Child(ren) $25.00
Provided by Nationwide
Employee + Family $40.00

Critical Illness
Basic Life and AD&D Accident Insurance
Long Term Disability Hospital Care
Employee Assistance Program Provided by Cigna
Travel Assistance
Employee Only No Charge
LifeLock Benefit Elite
Employee Only $3.92
Voluntary Legal Plan - Legal Shield
Employee + Spouse $7.84
Tier 1 (Basic benefit plus $7.36 Employee + Child(ren) $6.86
Legal Shield)
Employee + Family $10.78
Tier 2 (Tier 1 plus Identity $11.95
Theft)
LifeLock Ultimate Plus
Note Employee $11.76
You have the option for your Medical, HSA, Vision, Dental and Employee + Spouse $23.53
Flexible Spending Account premiums to be deducted from Employee + Child(ren) $16.67
your paycheck on a pre-tax or post-tax basis. If you elect Employee + Family $28.44
pre-tax, your premiums will be deducted from your paycheck
before federal (and in some cases, state) income and Social
Security taxes are deducted, thereby lowering your taxes and
increasing the amount of your take-home pay.

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