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Contributions Per Pay Period

This chart compares the per paycheck contributions for our Employee Benefit plans. Your cost for coverage will vary depending on the option and
level of coverage you choose. Employee contributions for Medical, Dental, and Vision are deducted from your paycheck with pre-tax dollars. This
means that contributions are taken from your earnings before taxes, resulting in lower taxes and increased take home pay. For your
convenience, your age-banded Supplemental Life and Voluntary Disability premiums have been pre-calculated for you when you go through
Online Open Enrollment.

Medical Anthem Anthem Anthem
Basic HSA Plan Premier HRA PPO Plan Premier Plus PPO Plan
Employee Only $27.00 $77.00 $212.50
Employee + Spouse $82.00 $173.00 $435.50
Employee + Child(ren) $73.00 $155.00 $503.00
Employee + Family $112.00 $225.00 $607.00
Dental Cigna
DPPO

Employee Only $5.21
Employee + Spouse $10.42
Employee + Child(ren) $11.84
Employee + Family $15.63
Vision VSP
PPO
Employee Only $3.33
Employee + One $6.65
Employee + Family $10.70
Voluntary Life and AD&D Cigna
Age Rated Age Rated premiums calculated for you during Online Enrollment

Optional Buy-up LTD Cigna
Age Rated Age Rated premiums calculated for you during Online Enrollment
Voluntary STD Cigna
Rate per $10 of weekly benefit $0.41
Total per pay check premiums are calculated for you during Online Enrollment

The following benefits are provided to you at no charge and are paid 100% by ABC Company:
• Basic Life and Basic Accidental Death and Dismemberment (AD&D)
• Basic Long Term Disability
• Life Assistance Program
• Business Travel Accident

The following benefits are provided to you as shared cost benefits between you and ABC Company:
• Medical
• Dental
• 401(k)

The following benefits are available to you at discounted group rates. Should you elect these benefits, you will pay 100% of the cost.
• Vision
• Voluntary Life and Accidental Death and Dismemberment (AD&D)
• Voluntary Short Term Disability
• Optional Buy-up Long Term Disability

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