Page 15 - Burlingame EE Guide 12-19 - English

TEAM MEMBER CONTRIBUTIONS

This chart compares the weekly contributions for our Team Member Benefit plans. Your cost for coverage will vary depending on
the option and level of coverage you choose.

Medical

EBA&M / Anthem Blue Cross EBA&M / Anthem Blue Cross
Exclusive Core Exclusive Buy-Up

Team Member Only $21.17 $34.02
Team Member + Spouse $67.69 $101.75
Team Member + Child(ren) $56.77 $80.55
Team Member + Family $ 95.69 $ 144.54

Dental
MetLife TDA MetLife MetLife
California DHMO Arizona DHMO Low DPPO High DPPO
Team Member Only $1.59 $1.23 $3.41 $8.47
Team Member + 1 Dependent $2.92 $2.39 $7.49 $22.40
Team Member + 2 or More Dependents $4.37 $3.45 $14.90 $34.32

Vision
MetLife
PPO

Team Member Only $0.67
Team Member + Spouse $1.34
Team Member + Child(ren) $1.18
Team Member + Family $1.72

The following benefits are provided to you at no charge and are paid by Burlingame Industries:
• Employee Assistance Program
• Basic Life/AD&D
• Short Term Disability
• 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

Payroll Direct Deposit

The direct deposit program allows for the automatic deposit of your net earnings into a checking or savings account at the financial
institution of your choice. This program is available to all team members. If you are interested in participating, you must complete
an authorization agreement form at the Human Resources office.

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