Page 15 - Column Five EE Guide 12-19 -California

EMPLOYEE CONTRIBUTIONS

This chart compares the monthly 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 in-
creased take home pay.

Medical

Kaiser
Permanente Kaiser Anthem Anthem Anthem Anthem
Silver 70 Permanente Silver Silver Gold Gold
HMO Gold 80 HMO PPO PPO PPO PPO
Plan 1000/55 0/30 55/1750/35% 40/1750/40% 30/750/20% 30/500/20%

Employee Only $0.00 $60.00 $30.00 $45.00 $80.00 $90.00
Spouse, Child(ren) For employees with 1 or more dependents covered on their medical, Column Five will contribute $100 /
month toward the cost of the dependent coverage. This is per family, not per dependent.
Dental

Guardian Guardian
Plan DHMO PPO

Employee Only $ 4.75 $ 23.03
Employee + Spouse $ 14.25 $ 72.59
Employee + Child(ren) $ 21.47 $ 91.36
Employee + Family $ 32.29 $140.91
Vision

Guardian
Plan PPO

Employee Only $ 6.03
Employee + Spouse $ 14.27
Employee + Child(ren) $ 14.67
Employee + Family $ 26.73

The following benefits are provided to you at no charge and are paid by Column Five Media:
• Employee Assistance Program
• Basic Life/AD&D
• Long Term Disability

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

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