Page 6 - Optima Tax EE Guide 01-20 CA

Contributions

Your cost per paycheck

Biweekly - 26 Payroll Deductions/Year

Medical Options
Basic Standard Network Premier
Plan PPO Only EPO PPO
Employee Only $50.98 $67.17 $182.90
Employee + Spouse $183.46 $220.69 $466.34
Employee + Child(ren) $129.07 $156.60 $316.00
Employee + Family $232.65 $279.60 $667.47

Dental Options
Plan DHMO PPO
Employee Only $0.92 $14.63
Employee + Spouse $9.87 $39.58
Employee + Child(ren) $11.62 $44.46
Employee + Family $23.30 $77.02

Vision Option
Plan PPO
Employee Only $0.92
Employee + Spouse $3.53
Employee + Child(ren) $3.19
Employee + Family $5.96

IRS Code Section 125
The Optima Tax Relief employee benefit plans are designed under Section 125 of the IRS Code. This allows you to
take advantage of federal laws by purchasing some of your benefits with pre-tax dollars. Under Section 125, your
Medical, Dental, Vision, and Flexible Spending Account contributions are deducted before taxes are withheld which
saves you tax dollars. Paying for benefits before-tax means that your share of the costs are deducted before taxes
are determined, resulting in more take-home pay for you. As a result, the IRS requires that your elections remain in
effect for the entire year. You cannot drop or change coverage unless you experience a qualifying event.

6 Employee Benefits