Page 10 - NickCo Hospitality_2018 EE Benefits Guide_Hourly Associates_FINAL
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YOUR MONTHLY CONTRIBUTIONS




         Medical

                                                                              Medical Elements HMO
            Associate Only                                                            $125.00
            Associate + Spouse                                                        $476.35
            Associate + Child(ren)                                                    $359.24
            Associate + Family                                                        $739.89
         Dental

                                                                                    Dental PPO
            Associate Only                                                            $19.43
            Associate + Spouse                                                        $58.93
            Associate + Child(ren)                                                    $58.93
            Associate + Family                                                        $115.22
         Vision
                                                                                    Vision PPO
            Associate Only                                                             $7.72
            Associate + Spouse                                                        $15.06
            Associate + Child(ren)                                                    $15.83
            Associate + Family                                                        $22.01




                                     RESOURCES AND CONTACTS




         Below is a list of insurance carrier contacts should you require assistance with your benefit questions following open enrollment. If
         you are unable to resolve your issues or questions with the insurance carriers, please contact the Home Office.


                                                     Anthem Blue Cross

           Medical
           Select Elements Choice HMO Member Services (279103H007)….....…………………………...  (800) 227-3560
           Carrier Website ………………………………………………………………….………………….……………………  www.anthem.com/ca
           Dental
           Dental Complete PPO Member Services (2791030001)……………..………….……………………  (877) 567-1804
           Carrier Website ………………………………………………………………….………………….……………………  www.anthem.com/ca
           Vision
           Blue View Vision Member Services (2791030003)…….…..……………………….……………………  (866) 723-0515
           Carrier Website ……………………………………………………………….…………………….……………………  www.anthem.com/ca





                            Educational Video
                            Benefits terminology can get confusing. Click here to watch a quick video to learn the basics of how our
                            medical plans work.

                            Deductibles, Copays, Coinsurance, and Out-of-Pocket Maximums
                            http://video.burnhambenefits.com/terms/





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