Page 24 - Burnham BG 2018-19 v4
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EMPLOYEE CONTRIBUTIONS
The tables below show the per-paycheck contributions for our employee benefit plans. Your cost for coverage
varies depending on the option and level of coverage you choose.
Burnham contributes 85% of the employee premiums and 50% of the dependent premiums for Medical, Dental
and Vision. EaseCentral and the tables below illustrate employee contributions after Burnham’s contributions
have been made toward the premiums.
Shared Cost Benefits
Plan Contribution Per Paycheck
Kaiser Permanente Platinum 0/15 HMO Plan
United Healthcare Platinum Signature 0 HMO
Refer to EaseCentral or see Rate Sheet
United Healthcare Gold Select Plus 1000 PPO
United Healthcare Silver Select Plus 2000 HSA
Guardian PPO Dental Plan
Employee Only $4.53
Employee + Spouse $21.20
Employee + Child(ren) $24.53
Employee + Family $41.63
Guardian Vision Plan (VSP Network)
Employee Only $0.81
Employee + Spouse $2.66
Employee + Child(ren) $2.75
Employee + Family $5.45
Burnham-Paid Benefits
Plan Coverage For
Employee Assistance Program Employee + Household
Basic Life and AD&D Insurance Employee Only
Long Term Disability Insurance Employee Only
Travel Assistance Employee Only
Employee-Paid Benefits
Plan Employee Cost
Voluntary Life and AD&D Insurance Refer to EaseCentral or see Rate Sheet
Voluntary Short Term Disability Insurance Refer to EaseCentral or see Rate Sheet
Flexible Spending Accounts Employee Determined
Commuter Benefit Program Employee Determined
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