Page 22 - Milani EE Benefits Booklet.pub

[EMPLOYEE BENEFITS]

EMPLOYEE CONTRIBUTIONS

This chart compares the weekly per paycheck 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 premiums have
been pre-calculated for you in EaseCentral.

MEDICAL HMO SELECT HMO VIVITY
NETWORK NETWORK HSA PPO PPO
Employee Only $10.00 $20.00 $30.00 $67.64
Employee + Spouse $140.00 $135.69 $190.00 $272.81
Employee + Spouse (w/other $165.00 $160.69 $215.00 $297.81
coverage)
Employee + Child(ren) $75.00 $97.12 $130.00 $197.76
Employee + Family $200.00 $222.45 $250.00 $366.69
Employee + Family (Spouse $225.00 $247.45 $275.00 $391.69
w/other coverage)
DENTAL DHMO PPO

Employee Only $2.00 $10.00
Employee + Spouse $4.00 $20.00
Employee + Child(ren) $3.00 $24.00
Employee + Family $8.00 $36.00
VISION PPO
Employee Only $0.50
Employee + Spouse $2.00
Employee + Child(ren) $1.00
Employee + Family $3.00

The following benefits are provided to you at no charge and are
paid by Milani:
 Basic Life and AD&D
 Short Term Disability (for non-CA employees)
 Long Term Disability
 Employee Assistance Program
 Travel Assistance Plan

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 and AD&D
 Short Term Disability (for CA employees)
 Flexible Spending Accounts
 Commuter Benefits
 Pet Insurance

22