Page 7 - Tender Greens EE Guide 01-20
P. 7

Team Member Portion
                                Plan                                             (Per Pay Period)
         Medical Options

         Narrow Network HMO
         Team Member Only                                                              $75
         Team Member + Spouse                                                          $208
         Team Member + Child(ren)                                                      $145
         Team Member + Family                                                          $287
         Full Network HMO
         Team Member Only                                                              $90
         Team Member + Spouse                                                          $250
         Team Member + Child(ren)                                                      $175
         Team Member + Family                                                          $345

         PPO HDHP
         Team Member Only                                                              $57
         Team Member + Spouse                                                          $157
         Team Member + Child(ren)                                                      $127
         Team Member + Family                                                          $226
         PPO
         Team Member Only                                                              $130
         Team Member + Spouse                                                          $336
         Team Member + Child(ren)                                                      $245
         Team Member + Family                                                          $467
         Dental Option

         Team Member Only                                                               $6
         Team Member + Spouse                                                          $16
         Team Member + Child(ren)                                                      $19
         Team Member + Family                                                          $27

         Vision Option
         Team Member Only                                                               $1
         Team Member + Spouse                                                           $3
         Team Member + Child(ren)                                                       $3
         Team Member + Family                                                           $5

         The following benefits are provided to you at no charge and   The following benefits are available to you at discounted group
         are paid by Tender Greens:                           rates. Should you elect these benefits, you will pay 100% of the
         •   Basic Life/AD&D                                  cost:
         •   Employee Assistance Program                      •   Voluntary Life/AD&D
         •   Travel Assistance                                •   Voluntary Short Term Disability
         •   Will Preparation Assistance                      •   Voluntary Long Term Disability


         For your convenience, your age-banded Voluntary Life/AD&D, Short
         Term Disability and Long Term Disability premiums have been


         pre-calculated for you in UltiPro.


                                                                                               Team Member Benefits
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