Page 16 - Westmark BG 2020

Rates and Contributions

This chart illustrates 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.
Per Paycheck
Employee Rate
Medical HMO - Blue Shield of California
Employee Only $0.00
Employee + 1 Dependent Age-banded
Employee + Family Age-banded
Medical PPO - Blue Shield of California

Employee Only $0.00
Employee + 1 Dependent Age-banded
Employee + Family Age-banded
Dental DHMO - Guardian

Employee Only $0.00
Employee + 1 Dependent $4.79
Employee + Family $10.45
Dental PPO - Guardian
Employee Only $0.00
Employee + 1 Dependent $18.05
Employee + Family $36.50

Vision - Guardian
Employee Only $0.00
Employee + Spouse $2.74
Employee + Child(ren) $3.13
Employee + Family $6.65
Basic Life and AD&D

Employee Only No Charge
Voluntary Life and AD&D

Employee Only 100% employee paid
Spouse Only 100% employee paid
Child(ren) Only 100% employee paid

Short Term Disability / Long Term Disability
Employee Only 100% employer paid

Pet Insurance
Varies by number of pets and program you choose www.unitedpetcare.com/westmark

NOTE:
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.

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