Page 15 - Bar Bakers EE Guide 09-17 English Final

BI-WEEKLY CONTRIBUTIONS

This chart compares the bi-weekly 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. Please note, Supplemental Benefit rates may be found on PayCom.

Anthem Blue Cross Anthem Blue Cross Anthem Blue Cross
Medical Low HMO Value High HMO Value Classic PPO

Employee Only $47.50 $98.87 $147.09
Employee + Spouse $275.48 $388.49 $494.59
Employee + Child(ren) $199.48 $291.95 $378.75
Employee + Family $446.46 $ 605.70 $ 755.20
United Concordia United Concordia
Dental DHMO PPO
Employee Only $6.40 $32.22
Employee + 1 Dependent $11.78 $64.01
Employee + Family $18.71 $106.22
EyeMed Vision Care
Vision PPO
Employee Only $3.91
Employee + 1 Dependent $7.43
Employee + Family $10.91

The following benefits are provided to you at no charge and are paid by Bar Bakers:
• Employee Assistance Program
• Basic Life and AD&D
• Travel Assistance Program
• Health Advocate

15