Page 15 - JFSLA - Benefits Guide 2018-2019 - FINAL

Employee Contributions

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

Monthly Bi-Weekly
Employee Rate Employee Rate

Medical—Vivity Classic HMO
Employee Only $39.47 $18.22
Employee + 1 $842.63 $388.91
Employee + 2 or more $1499.74 $692.19

Medical—Classic HMO
Employee Only $169.98 $78.45
Employee + 1 $1,116.68 $515.39
Employee + 2 or more $1,891.25 $872.89
Medical—PPO HSA 2700/20

Employee Only $326.64 $150.76
Employee + 1 $1,445.67 $667.23
Employee + 2 or more $2,361.25 $1,089.81
Medical—Classic PPO
Employee Only $758.62 $350.13
Employee + 1 $2,352.84 $1,085.93
Employee + 2 or more $3,657.18 $1,687.93

Dental HMO
Employee Only $0.00 $0.00
Employee + 1 $18.51 $8.54
Employee + 2 or more $41.65 $19.22
Dental PPO
Employee Only $39.34 $18.16
Employee + 1 $102.08 $47.11
Employee + 2 or more $175.55 $81.02
Vision
Employee Only $0.00 $0.00
Employee + 1 $3.16 $1.46
Employee + 2 or more $8.42 $3.89

Basic Life and AD&D - Anthem
Employee Only 0%
Voluntary Life and AD&D - Anthem
Employee Only 100%
Spouse Only 100%
Child(ren) Only 100%

Long Term Disability - UNUM
Employee Only 0%

*Please note that these charts compare the per-paycheck and monthly contributions for our Employee Benefit plans. Your cost for
coverage will vary depending on the option and level of coverage you choose. Your 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.
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