Page 17 - Volcom Benefit Summary 2018 Texas

EMPLOYEE CONTRIBUTIONS

This chart compares the 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. Contributions for domestic partner coverage are taken after-tax
due to IRS regulations.

EMPLOYEE COST PER PAYCHECK
MEDICAL OPTIONS
Option 1: HSA PPO Plan Under 5 Years From 5 to 10 Years Over 10 Years
Employment Employment Employment
Employee Only $68.20 $56.59 $36.27
Employee + Spouse $181.67 $156.17 $111.55
Employee + Child(ren) $151.42 $129.39 $90.85
Employee + Family $294.96 $259.74 $198.11
Option 2: PPO Buy-Up Plan Under 5 Years From 5 to 10 Years Over 10 Years
Employment Employment Employment
Employee Only $122.87 $105.06 $87.25
Employee + Spouse $262.06 $222.95 $183.84
Employee + Child(ren) $233.13 $199.34 $165.56
Employee + Family $426.83 $372.80 $318.77
DENTAL OPTIONS
Option 1: DHMO Plan
Employee Only $2.54
Employee + Spouse $8.88
Employee + Child(ren) $9.59
Employee + Family $15.58
Option 2: DPPO Plan
Employee Only $13.99
Employee + Spouse $43.75
Employee + Child(ren) $51.20
Employee + Family $67.57
VISION
Employee Only $1.31
Employee + 1 $3.16
Employee + 2 or More $6.07
BASIC LIFE AND AD&D / LONG TERM DISABILITY / EMPLOYEE ASSISTANCE
PROGRAM
Employee Only No Charge
VOLUNTARY LIFE AND AD&D / SUPPLEMENTAL BENEFITS
Employee / Dependents 100% of Cost. For your convenience, your voluntary
premiums have been pre-calculated for you in ADP.

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