Page 21 - Inglewood USD Benefits Guide 2019 - Actives Final

EMPLOYEE CONTRIBUTIONS

CLASSIFIED & CONFIDENTIAL

Anthem Blue Cross Employees working 7-8 Employees working less Employees working less Employees working less
Classic PPO hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
500/30/20 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 $947.57 $644.41 $947.57 $644.41 $1,189.22 $402.76 $1,269.77 $322.21
Employee + 1 $1,989.86 $1,349.33 $2,327.20 $1,012.00 $2,495.86 $843.33 $2,664.53 $674.66
Employee + Family $2,842.68 $1,926.06 $3,324.20 $1,444.55 $3,564.95 $1,203.79 $3,805.71 $963.03

Anthem Blue Cross Employees working 7-8 Employees working less Employees working less Employees working less
Solutions PPO hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
2000/20/20 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 $632.78 $644.41 $632.78 $644.41 $874.44 $402.76 $954.99 $322.21
Employee + 1 $1,328.81 $1,349.33 $1,666.14 $1,012.00 $1,834.81 $843.33 $2,003.47 $674.66
Employee + Family $1,898.32 $1,926.06 $2,379.83 $1,444.55 $2,620.59 $1,203.79 $2,861.35 $963.03
Dental Plan – 2019 Tenthly Premiums
3
Delta Dental PPO 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 IUSD Pays 1 EE Pays 2 IUSD Pays

Employee Only $0.00 $63.35 $0.00 $63.35 $23.76 $39.59 $31.67 $31.67
Employee + 1 $0.00 $114.73 $28.68 $86.05 $43.02 $71.71 $57.37 $57.37
Employee + Family $0.00 $164.95 $41.24 $123.71 $61.86 $103.10 $82.48 $82.48
Vision Plan – 2019 Tenthly Premiums
3
VSP Vision PPO 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 IUSD Pays 1 EE Pays 2 IUSD Pays
Employee Only $0.00 $14.51 $0.00 $14.51 $5.44 $9.07 $7.25 $7.25
Employee + 1 $0.00 $26.95 $6.74 $20.21 $10.11 $16.85 $13.48 $13.48
Employee + Family $0.00 $41.51 $10.38 $31.13 $15.57 $25.94 $20.75 $20.75

1
EE indicates the amount you as the employee would be responsible for on a tenthly basis.
2
ER reflects the portion covered by Inglewood Unified School District on a tenthly basis.
3
Rates are calculated tenthly and paid through payroll deductions.
*Part-time unit members regularly assigned less than full-time, but more than four (4) hours or more, five (5) days per week, are
eligible for District contribution as outlined above.
The following benefits are available to you at discounted group rates. Should you elect these benefits, you will
pay 100% of the cost:

• Voluntary Life/AD&D
• Short Term Disability
• Universal Life with Long Term Care
• Accident
• Critical Illness
• Commuter Benefit
• Flexible Spending Accounts

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