Page 15 - California Eye Management EE Guide 2019

Employee Contributions

This chart compares the monthly and bi-weekly 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 and Dental 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.

California Eye Specialists’ Your Your
Monthly Premium Monthly Cost Bi-Weekly Cost
(26 Pay Periods)
Medical Options
Plan Type: HMO Medical Plan

Employee Only $325.72 $114.00 $52.62
Employee + Spouse $716.55 $504.83 $233.00
Employee + Child(ren) $586.26 $374.54 $172.87
Employee + Family $1,009.68 $797.96 $368.29

Plan Type: Deductible HMO Medical Plan
Employee Only $369.09 $157.37 $72.63
Employee + Spouse $811.95 $600.23 $277.03
Employee + Child(ren) $664.32 $452.60 $208.89
Employee + Family $1,144.11 $932.39 $430.33
Plan Type: HSA Medical Plan

Employee Only $446.75 $235.03 $108.48
Employee + Spouse $982.86 $771.14 $355.91
Employee + Child(ren) $804.15 $592.43 $273.43
Employee + Family $1,384.92 $1,173.20 $541.48
Plan Type: PPO Medical Plan

Employee Only $629.19 $417.47 $192.68
Employee + Spouse $1,384.21 $1,172.49 $541.15
Employee + Child(ren) $1,132.52 $920.80 $424.99
Employee + Family $1,950.47 $1,738.75 $802.50
Dental
Plan Type: DHMO Dental Plan

Employee Only $11.48 $4.02 $1.85
Employee + Spouse $22.95 $15.49 $7.15
Employee + Child(ren) $22.95 $15.49 $7.15
Employee + Family $37.31 $29.85 $13.78

Plan Type: DPPO Dental Plan
Employee Only $34.10 $26.64 $12.29
Employee + Spouse $69.56 $62.10 $28.66
Employee + Child(ren) $77.70 $70.24 $32.42
Employee + Family $118.10 $110.64 $51.06

The following benefits are provided to you at no charge and are paid by California Eye Specialists:
• Employee Assistance Program
• Basic Life and AD&D

15