Page 20 - Inglewood USD Benefits Guide 2019 - Actives Final

EMPLOYEE CONTRIBUTIONS

CLASSIFIED & CONFIDENTIAL

This chart compares the tenthly 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/AD&D premiums have been pre-calculated for
you in PlanSource.

Medical Plans – 2019 Tenthly Premiums
3
Kaiser HMO $10 Employees working 7-8 Employees working less Employees working less Employees working less
hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
hours per day hours per day hours per day
1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSDPays 1 EE Pays 2 IUSD Pays
Employee Only $182.72 $644.41 $182.72 $644.41 $424.38 $402.76 $504.93 $322.21
Employee + 1 $285.74 $1,349.33 $623.08 $1,012.00 $791.74 $843.33 $960.41 $674.66
Employee + Family $379.58 $1,926.06 $861.10 $1,444.55 $1,101.86 $1,203.79 $1,342.61 $963.03

Kaiser HMO $20 Employees working 7-8 Employees working less Employees working less Employees working less
hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
hours per day hours per day hours per day
1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSDPays 1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSDPays
Employee Only $151.20 $644.41 $151.20 $644.41 $392.85 $402.76 $473.41 $322.21
Employee + 1 $222.70 $1,349.33 $560.03 $1,012.00 $728.69 $843.33 $897.36 $674.66
Employee + Family $290.38 $1,926.06 $771.89 $1,444.55 $1,012.65 $1,203.79 $1,253.41 $963.03

Anthem Blue Cross Employees working 7-8 Employees working less Employees working less Employees working less
Vivity HMO hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
10/100% hours per day hours per day hours per day
1 2 1 2 1 2 1 2
EE Pays IUSDPays EE Pays IUSD Pays EE Pays IUSD Pays EE Pays IUSD Pays
Employee Only $0.00 $644.41 $0.00 $644.41 $241.65 $402.76 $322.21 $322.21
Employee + 1 $0.00 $1,349.33 $337.33 $1,012.00 $506.00 $843.33 $674.66 $674.66
Employee + Family $0.00 $1,926.06 $481.52 $1,444.55 $722.27 $1,203.79 $963.03 $963.03

Anthem Blue Cross Employees working 7-8 Employees working less Employees working less Employees working less
Select HMO hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
15/30/250 hours per day hours per day hours per day
1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSD Pays

Employee Only $0.00 $631.68 $0.00 $631.68 $228.92 $402.76 $309.47 $322.21
Employee + 1 $0.00 $1,322.57 $310.57 $1,012.00 $479.24 $843.33 $647.90 $674.66
Employee + Family $0.00 $1,887.84 $443.30 $1,444.55 $684.05 $1,203.79 $924.81 $963.03

Anthem Blue Cross Employees working 7-8 Employees working less Employees working less Employees working less
Vivity HMO hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
30/40/500 hours per day hours per day hours per day
1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSD Pays 1 EE Pays 2 IUSD Pays

Employee Only $0.00 $574.86 $0.00 $574.86 $172.10 $402.76 $252.65 $322.21
Employee + 1 $0.00 $1,203.25 $191.26 $1,012.00 $359.92 $843.33 $528.59 $674.66
Employee + Family $0.00 $1,717.39 $272.85 $1,444.55 $513.60 $1,203.79 $754.36 $963.03

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