Page 15 - CW Driver Benefit Guide 2019 MAIN

PREMIUM COSTS

The following annual premium costs are paid for by C.W. Driver for employees and
their dependents.
ANNUAL PREMIUM COST
PAID BY C.W. DRIVER

Medical Option 1: Kaiser Permanente HMO
Employee Only $5,774.52
Employee + Spouse $12,703.92
Employee + Child(ren) $11,549.04
Employee + Family $17,323.56
Medical Option 2: Anthem Blue Cross HMO

Employee Only $6,695.40
Employee + Spouse $14,729.88
Employee + Child(ren) $12,051.72
Employee + Family $20,755.68
Medical Option 3: Anthem Blue Cross PPO HIA
Employee Only $8,001.00
Employee + Spouse $17,603.52
Employee + Child(ren) $14,402.88
Employee + Family $24,805.08
Dental Option 1: Anthem Blue Cross DHMO
Employee Only $185.25
Employee + Spouse $370.56
Employee + Child(ren) $370.56
Employee + Family $607.16
Dental Option 2: Anthem Blue Cross PPO

Employee Only $504.36
Employee + Spouse $1,098.36
Employee + Child(ren) $999.24
Employee + Family $1,571.04
Vision: Anthem Blue Cross Vision

Employee Only $78.12
Employee + 1 Dependent $148.44
Employee + 2 or More Dependents $227.52
EAP: Anthem Blue Cross

Employee + Household No Cost
Basic Life and AD&D: Hartford / Anthem Blue Cross
Hartford: 1x Salary $0.15 per $1,000 of Benefit
Anthem Blue Cross: $15,000 $0.27 per $1,000 of Benefit
Voluntary Benefits

Employee 100% of Cost paid by Employee
Spouse 100% of Cost paid by Employee
Child(ren) 100% of Cost paid by Employee

Page 14