Page 15 - Teacher Created Materials EE Guide 09-18 - CA

Employee Contributions

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 Voluntary Life and AD&D, Voluntary Short Term Disability,
Voluntary Long Term Disability, and Identity Theft premiums have been pre-calculated for you in Paycom.

Rate Per Paycheck Advantage Full
Network Network
Enrollment Tier HMO Plan HMO Plan PPO Plan DHMO Plan PPO Plan Vision Plan

Employee Only $50.27 $54.95 $67.91 $1.68 $5.32 $0.69
Employee + Spouse $213.63 $233.53 $288.60 $9.86 $35.36 $3.14
Employee + Child(ren) $175.93 $192.32 $237.67 $9.86 $35.36 $3.26
Employee + Family $376.99 $412.11 $509.28 $16.60 $73.22 $6.94

Employee Only No Charge

The following benefits are available to you at discounted group rates. Should you elect these benefits, you will pay 100% of the cost:
• Voluntary Life and AD&D
• Voluntary Short Term Disability
• Voluntary Long Term Disability
• Identity Protection
• Pet Insurance

How to Print Temporary ID Cards

Medical
Step 1: Register on www.myuhc.com
Step 2: Enter member ID # received from HR Department and Group #905826 for PPO / #358311 for Full HMO / #361604 for
Advantage HMO. Click No ID card to register; PPO members may use their Social Security Number and date of birth to
register
Step 3: Create Username and Password
Step 4: Enter email address and choose Security Questions, and click Submit
Step 5: Under My Account Settings, click Temporary ID Card - Medical

*Temporary ID card will be available after 72 hours once registered

Dental
Step 1: Register on www.mycigna.com
Step 2: Under Review My Coverage, click on Dental
Step 3: On the right-hand side, select the drop down menu for Related Links
Step 4: Select Print or Request ID Cards

Vision
Step 1: Register on www.vsp.com
Step 2: Under the Benefits & Claims tab, click on How to Use My Benefits
Step 3: Select Member Vision Card
Step 4: Print and save your VSP card

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