Page 18 - 5.11 Benefit Guide 2018 CA

TOBACCO CESSATION PROGRAM

5.11 is committed to providing choices that can lead to healthier living for our employees and their families. In partnership
with the American Lung Association, we offer a smoking cessation program to all our employees at no cost. The Freedom
From Smoking Online Premium program (www.ffsonline.org) consists of eight numbered modules and each module contains
several lessons. Members also have access to the online support community through message boards. The Certificate of
Participation will be provided to you after you complete the program. If you are a tobacco user and complete this program,
you will be eligible for the discounted non-tobacco medical plan payroll deductions. The discount will begin with the 1st
payroll cycle following the date of completion. Please contact our Human Resources Department to get access to the
Freedom From Smoking Online Premium membership.

EMPLOYEE CONTRIBUTIONS PER PAY-PERIOD

This chart compares the per pay-period 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.

MEDICAL
Option 1: HSA Non-Tobacco EMPLOYER-PAID BENEFITS
Standard Rate Discounted Rate • Employee Assistance Program
Employee Only $74.32 $64.32 • Basic Life/AD&D
Employee + Spouse $177.87 $167.87 • Long Term Disability
Employee + Child(ren) $161.22 $151.22
Employee + Family $262.29 $252.29 VOLUNTARY EMPLOYEE-
Option 2: PPO Non-Tobacco
Standard Rate Discounted Rate PAID BENEFITS
Employee Only $57.64 $47.64 • Voluntary Life/AD&D
Employee + Spouse $139.20 $129.20
Employee + Child(ren) $126.69 $116.69 IMPORTANT
Employee + Family $204.67 $194.67 To qualify for the discounted non-
Option 3: HMO Non-Tobacco tobacco rates you must either sign
Standard Rate Discounted Rate a Non-Tobacco User Affidavit or
Employee Only $74.52 $64.52 complete a 5.11 Tobacco-Cessation
Employee + Spouse $178.40 $168.40 Program.
Employee + Child(ren) $161.70 $151.70
Employee + Family $263.08 $253.08

DENTAL
Employee Only $10.00
Employee + Spouse $20.00
Employee + Child(ren) $25.00
Employee + Family $40.00
VISION

Employee Only $1.50
Employee + Spouse $2.50
Employee + Child(ren) $2.00
Employee + Family $4.00
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