Page 11 - ASMS Employee Guide 2017

Employee Contributions

This chart compares the monthly and per paycheck contributions for our Employee Benefit plans.
Your cost for coverage will vary depending on the option and level of coverage you choose.

Employee Rate Employee Rate
Per Month Per Paycheck

Medical HMO - Select Value HMO 30/40/30% (Limited Network)
Employee Only $118.65 $59.32
Employee + Spouse $550.11 $275.05 Note
Employee + Child(ren) $406.28 $203.14 Employee
Employee + Family $873.69 $436.84
contributions for
Medical HMO - Value HMO 30/40/30% (Full Network) Medical, Dental
and Vision are
Employee Only $198.16 $99.08 deducted from
Employee + Spouse $725.01 $362.50 your paycheck
Employee + Child(ren) $549.39 $274.69
with pre-tax
Employee + Family $1,120.15 $560.07
dollars. This
Medical PPO HSA - Lumenos HSA 2000 10/30 means that
contributions are
Employee Only $295.77 $147.88 taken from your
Employee + Spouse $939.78 $469.89
earnings before
Employee + Child(ren) $725.11 $362.55 taxes – resulting
Employee + Family $1,422.78 $711.39
in lower taxes and
Dental DHMO - Anthem Blue Cross increased take
home pay.
Employee Only $12.23 $6.12
Employee + Spouse $24.46 $12.23
Employee + Child(ren) $24.46 $12.23
Employee + Family $39.74 $19.87
Dental PPO - Anthem Blue Cross

Employee Only $37.93 $18.97
Employee + Spouse $75.08 $37.54
Employee + Child(ren) $91.68 $45.84
Employee + Family $128.82 $64.41
Vision - Anthem Blue Cross

Employee Only $8.07 $4.04
Employee + Spouse $15.74 $7.87
Employee + Child(ren) $16.54 $8.27
Employee + Family $22.99 $11.50
Basic Life and AD&D - Anthem Blue Cross
Employee Only 100% employer paid 100% employer paid

Voluntary Long-Term Disability - Assurant

Employee Only - Age Rated 100% employee paid 100% employee paid
Request personalized rate sheet
from Human Resources Dept.

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