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EMPLOYEE CONTRIBUTIONS

Your Cost Per Paycheck

24 Payroll Deductions per Year

This chart compares the 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 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. For your convenience, your age-banded Voluntary Life/AD&D premiums have been pre-calculated
for you in Ease.

Medical : Your employer contribution of $450 is reflected in the rates listed below.

United United United United United United
Healthcare Healthcare Healthcare Healthcare Healthcare Healthcare
HMO Advantage Focus HMO Alliance Select Plus Select Plus
20-30/20% HMO 15-30/750A HMO BILS PPO AHV1 PPO
Plan 20-30/20% 25-40/30%

Employee Only $121.90 $93.18 $84.74 $27.21 $511.18 $213.57
Employee + 1 $503.48 $443.18 $425.45 $304.64 $1320.98 $695.99
Employee + Family $815.69 $729.54 $704.21 $531.63 $1983.54 $1090.70

Dental & Vision

Guardian
DHMO Guardian Guardian
Plan Dental PPO Dental Vision
Employee Only $7.07 $34.18 $3.07
Employee + 1 $12.47 $72.37 $5.35
Employee + Family $19.14 $125.09 $9.06

The following benefits are provided to you at no The following benefits are available to you at
charge and are paid by Petroleum Marketing discounted group rates. Should you elect these
Equipment: benefits, you will pay 100% of the cost:
• Employee Assistance Program • Voluntary Life/AD&D
• Basic Life/AD&D
• Will Prep Services
• College Tuition Rewards

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