Page 31 - Realty One Benefits Guide CA

PER PAYCHECK CONTRIBUTIONS
MEDICAL OPTIONS: ANTHEM BLUE CROSS

SELECT HMO CLASSIC HMO LUMENOS SOLUTION CLASSIC
PLAN NAME
30/40 500 ADMIT 30/40 500 ADMIT HSA PPO 501 PPO 1500 PPO 750 30/20
Coverage Tier
• Employee Only $88.00 $109.32 $71.72 $106.55 $137.06
• Employee + Spouse $233.93 $290.60 $190.65 $283.26 $364.34
• Employee + Child(ren) $191.40 $237.76 $155.99 $231.76 $298.10
• Employee + Family $329.63 $409.48 $268.65 $399.13 $513.38

DENTAL / VISION OPTIONS: ANTHEM BLUE CROSS

DENTAL DENTAL
PLAN NAME VISION
DHMO 2000C DPPO
Coverage Tier
• Employee Only $8.29 $22.18 $3.86
• Employee + Spouse $16.58 $44.30 $6.56
• Employee + Child(ren) $16.58 $59.43 $6.95 /CONTRIBUTIONS
• Employee + Family $26.94 $85.79 $10.42

EMPLOYER-PAID BENEFITS
The following benefits are provided to you at no charge and are paid by Realty ONE Group:
• Basic Life and AD&D
• Short Term Disability
• Long Term Disability
• Employee Assistance Program

EMPLOYEE-PAID BENEFITS
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
• Voluntary AD&D
• Voluntary Products
• Pet Insurance

For your convenience, Voluntary Life and Voluntary Product rates have been pre-calculated for you in PlanSource. For Pet
Insurance rates, please log in to www.petinsurance.com/realtyone or call (877) 738-7874.
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