Page 17 - Razer Benefits Guide 1-18 No CA_PRINT

EMPLOYEE CONTRIBUTIONS

EMPLOYEE COST PER PAYCHECK
MEDICAL VOLUNTARY LIFE AND AD&D (Per $1,000)
KAISER PERMANENTE HMO AGE EMPLOYEE/SPOUSE

Employee Only $23.60 Under 20 $0.023
Employee + Spouse $135.63 20-29 $0.029
Employee + Child(ren) $112.10 30-34 $0.037
Employee + Family $178.71 35-39 $0.042
AETNA HMO 40-44 $0.050
Employee Only $25.16 45-49 $0.076
50-54
$0.121
Employee + Spouse $135.24
Employee + Child(ren) $122.66 55-59 $0.198
60-64
$0.305
Employee + Family $195.00
AETNA HSA PPO* 65-69 $0.586
70-74
$1.031
Employee Only $19.46 75-99 $2.08
Employee + Spouse $104.58 Child(ren) at $10K $0.115
Employee + Child(ren) $94.86 VOLUNTARY ACCIDENT
Employee + Family $150.79 Employee Only $12.92
*Razer contributes $38.46 to employee, and $76.92
to family HSA bank accounts each pay-period. Employee + Spouse $21.15
Employee + Child(ren)
$21.77
AETNA PPO Employee + Family $29.99
Employee Only $27.75 VOLUNTARY CRITICAL ILLNESS
Employee + Spouse $149.15 With Cancer Monthly Rates per $1,000
Employee + Child(ren) $135.27
Employee + Family $215.05 ISSUE AGES NON-TOBACCO TOBACCO
DENTAL < 25 $0.277 $0.425
$0.531
$0.318
CIGNA DHMO 25-29 $0.434 $0.780
30-34
Employee Only $0.66 35-39 $0.595 $1.140
Employee + Spouse $2.88 40-44 $0.858 $1.685
Employee + Child(ren) $4.27 45-49 $1.209 $2.409
Employee + Family $5.95 50-54 $1.657 $3.305
CIGNA PPO 55-59 $2.280 $4.426

Employee Only $2.52 60-64 $3.120 $5.686
Employee + Spouse $12.62 65-69 $4.140 $7.015
Employee + Child(ren) $13.22 70 + $5.197 $7.943
Employee + Family $20.25 Wellness Benefit: Add $0.74/paycheck
VISION Please contact the Unum enrollment team for more
Employee Only $0.00 information on pricing
Employee + Spouse $2.15 PET INSURANCE
Employee + Child(ren) $2.19 BI-WEEKLY PREFERRED SELECT
Employee + Family $3.54 RATES PROGRAM PROGRAM
EAP / BASIC LIFE AND AD&D / STD / LTD / 1 Pet $4.89 $4.04
TRAVEL ASSISTANCE 2 Pets $9.32 $7.66
No Charge 3 Pets $13.66 $11.22
VOLUNTARY AD&D Each $4.29 $3.55
All Ages $0.019 Additional Pet

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