Page 11 - Benefits Guide TeleSign 2020

Employee Contributions

This chart outlines the monthly and per-tax contributions for our plans. Your cost for coverage will vary depending on the option
and level of coverage you select. Medical and dental contributions are deducted before taxes are withheld which saves you tax
dollars. As a result, the IRS requires that your elections remain in effect for the entire year. You cannot drop or change coverage
unless you experience a qualifying event.

The vision, life and AD&D and long term disability benefits are provided at no cost to you and are funded entirely by TeleSign.

Monthly Employee Rate Per-Paycheck Employee Rate
Medical HMO (CA Employees Only) - Anthem Blue Cross

Employee Only $0.00 $0.00
Employee + Spouse $295.70 $147.85
Employee + Child(ren) $196.98 $98.49
Employee + Family $517.07 $258.54

Medical Traditional PPO - Anthem Blue Cross

Employee Only $251.02 $125.51
Employee + Spouse $672.72 $336.36
Employee + Child(ren) $532.14 $266.07
Employee + Family $988.99 $494.50

Medical High Deductible Health Plan - Anthem Blue Cross
Employee Only $30.75 $15.38
Employee + Spouse $397.37 $198.69
Employee + Child(ren) $275.17 $137.59
Employee + Family $672.34 $336.17
Dental PPO - Anthem Blue Cross

Employee Only $0.00 $0.00
Employee + Spouse $28.88 $14.44
Employee + Child(ren) $34.11 $17.05
Employee + Family $66.01 $33.01
Vision PPO - Anthem Blue Cross
Employee Only $0.00 $0.00
Employee + Spouse $0.00 $0.00
Employee + Child(ren) $0.00 $0.00
Employee + Family $0.00 $0.00
Voluntary Life (Employee and Spouse Rates) - Anthem Blue Cross

Under age 29 $0.07 per $1,000
Age 30 to 34 $0.08 per $1,000
Age 35 to 39 $0.10 per $1,000
Age 40 to 44 $0.17 per $1,000 To calculate your monthly cost, locate
Age 45 to 49 $0.25 per $1,000 your age band and divide your election
Age 50 to 54 $0.40 per $1,000 amount by 1,000. Multiply the result by
Age 55 to 59 $0.64 per $1,000 your age rate to determine your monthly
Age 60 to 64 $0.93 per $1,000 premium. Please note that the spouse
Age 65 to 69 $1.60 per $1,000 rate is based on the employee’s age.
Age 70 to 74 $3.59 per $1,000
Age 75 to 99 $8.51 per $1,000
Child(ren) Only $0.20 per $1,000

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