Page 17 - Razer Benefits Guide 1-18 No CA

EMPLOYEE CONTRIBUTIONS

EMPLOYEE COST PER PAYCHECK
MEDICAL VOLUNTARY LIFE AND AD&D (Per $1,000)
KAISER PERMANENTE HMO AGE EMPLOYEE/SPOUSE

Employee Only $23.60 Under 20 $0.023
Employee + Spouse $135.63 20-29 $0.029
Employee + Child(ren) $112.10 30-34 $0.037
Employee + Family $178.71 35-39 $0.042
AETNA HMO 40-44 $0.050

Employee Only $25.16 45-49 $0.076
50-54
$0.121
Employee + Spouse $135.24
Employee + Child(ren) $122.66 55-59 $0.198
60-64
$0.305
Employee + Family $195.00
AETNA HSA PPO* 65-69 $0.586
$1.031
70-74
Employee Only $19.46 75-99 $2.08
Employee + Spouse $104.58 Child(ren) at $10K $0.115
Employee + Child(ren) $94.86 PET INSURANCE
Employee + Family $150.79 BI-WEEKLY PREFERRED SELECT
*Razer contributes $38.46 to employee, and $76.92 RATES PROGRAM PROGRAM
to family HSA bank accounts each pay-period. 1 Pet $4.89 $4.04
AETNA PPO 2 Pets $9.32 $7.66
Employee Only $27.75 3 Pets $13.66 $11.22
Employee + Spouse $149.15 Each $4.29 $3.55
Employee + Child(ren) $135.27 Additional Pet
Employee + Family $215.05
DENTAL
CIGNA DHMO

Employee Only $0.66
Employee + Spouse $2.88
Employee + Child(ren) $4.27
Employee + Family $5.95
CIGNA PPO

Employee Only $2.52
Employee + Spouse $12.62
Employee + Child(ren) $13.22
Employee + Family $20.25
VISION
Employee Only $0.00
Employee + Spouse $2.15
Employee + Child(ren) $2.19
Employee + Family $3.54
EAP / BASIC LIFE AND AD&D / STD / LTD /
TRAVEL ASSISTANCE
No Charge
VOLUNTARY AD&D
All Ages $0.019

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