Page 13 - L'Abri Management 2020 Benefits Guide

Employee Contributions

This chart compares the monthly and per paycheck contributions for L’Abri Management Inc’s Employee Benefit plans for the
period of 1/1/2020-12/31/2020. Your cost for coverage will vary depending on the option and level of coverage you choose.
Employee contributions for Medical, Dental, Vision, and Voluntary Life/AD&D are deducted from your paycheck.

Employee Rate Per Month Employee Rate Per Paycheck
Medical - Blue Shield Trio HMO

Employee Only $122.93 $61.47
Employee + Spouse $932.90 $466.45
Employee + Child(ren) $559.07 $279.54
Employee + Family $1,306.72 $653.36
Medical HMO - Blue Shield Access+ HMO

Employee Only $204.03 $102.02
Employee + Spouse $1,195.98 $597.99
Employee + Child(ren) $738.16 $369.08
Employee + Family $1,653.79 $826.90
Dental HMO - Cypress

Employee Only $14.17 $7.09
Employee + Spouse $27.64 $13.82
Employee + Child(ren) $28.91 $14.46
Employee + Family $45.34 $22.67
Dental PPO - Cypress
Employee Only $53.87 $26.94
Employee + Spouse $105.60 $52.80
Employee + Child(ren) $118.98 $59.49
Employee + Family $170.71 $85.36
Vision - Sun Life
Employee Only $11.94 $5.97
Employee + Spouse $23.88 $11.94
Employee + Child(ren) $26.27 $13.14
Employee + Family $38.21 $19.11
The following benefits are provided to you at no The following benefits are available to you at
charge and are paid by L’Abri Management Inc: discounted group rates. Should you elect these
• Basic Life/AD&D benefits, you will pay 100% of the cost:
• Employee Assistance Program • Dental
• Travel Assistance • Vision
• Voluntary Life/AD&D

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