Page 13 - Tender Greens Benefit Guide Sample

EMPLOYEE CONTRIBUTIONS

This chart compares the per paycheck contributions for our Employee Benefit plans. Your cost for coverage will vary depend-
ing 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/AD&D and Voluntary
Short Term Disability premiums have been pre-calculated for you in UltiPro.

Medical

Blue Shield Blue Shield Blue Shield Blue Shield
Plan Narrow HMO HMO HMO PPO

Employee Only $50 $90 $100 $110
Employee + Spouse $150 $170 $180 $190
Employee + Child(ren) $120 $140 $150 $160
Employee + Family $250 $280 $290 $300
Dental

Assurant
Plan PPO

Employee Only $20
Employee + Spouse $60
Employee + Child(ren) $75
Employee + Family $100

Vision

VSP
Plan PPO

Employee Only $6
Employee + Spouse $12
Employee + Child(ren) $11
Employee + Family $ 22

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