Page 6 - Veritone EE California and Colorado Benefit Guide_2019

Your cost per month

Medical HMO Options Option 1 Option 2 Option 3 IRS CODE Section 125

Plan Kaiser CA HMO Anthem CA HMO Kaiser CO HMO The Veritone employee benefit plans
are designed under Section 125 of the
Employee Only $78.91 $87.25 $83.09 IRS Code. This allows you to take
Employee + Spouse $182.28 $191.93 $182.79 advantage of federal laws by
Employee + Child(ren) $160.97 $157.04 $149.56 purchasing some of your benefits with
Employee + Family $239.09 $270.45 $257.57 pre-tax dollars. Under Section 125,
Medical PPO Options Option 4 Option 5 Option 6 your Medical, Dental, Vision, and
Flexible Spending Account
Plan PPO $500 PPO $1,500 HSA PPO contributions are deducted before taxes

Employee Only $136.91 $107.25 $79.35 are withheld which saves you tax
Employee + Spouse $301.20 $235.94 $174.79 dollars. Paying for benefits before-tax
Employee + Child(ren) $246.44 $193.05 $142.83 means that your share of the costs is
Employee + Family $424.41 $332.47 $246.00 deducted before taxes are determined,
resulting in more take-home pay for
Dental Options Option 1 Option 2 you. As a result, the IRS requires that

Plan PPO High PPO Low your elections remain in effect for the
entire year. You cannot drop or change
Employee Only $14.04 $7.36 coverage unless you experience a
Employee + Spouse $28.47 $16.05 qualifying event. You may waive
Employee + Child(ren) $31.74 $15.47 participation in the Section 125 Plan
Employee + Family $45.01 $22.31 and elect to pay all contributions with
after-tax dollars. Contact the Human
Vision Option
Resources Department if you wish to
Plan PPO pay for your benefits with after-tax
dollars.
Employee Only $1.37
Employee + Spouse $2.74
Employee + Child(ren) $2.80
Employee + Family $4.17