Page 15 - TCR Benefit Guide 2017 - sent 9.12.17

Employee Contributions

This chart compares 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. 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.
Medical Dental Vision
Select Value Select Classic PPO DHMO Plan PPO Plan Vision
Enrollment Tier Deductible HMO HMO
Employee Only (EE) $60.32 $81.43 $233.61 $0.00 $20.41 $0.00
Employee + Spouse (ES) $349.84 $396.28 $731.10 $6.56 $45.20 $1.67
Employee + Child(ren) (EC) $253.34 $291.33 $565.27 $6.73 $47.22 $1.90
Employee + Family (EF) $566.99 $632.42 $1,104.21 $13.28 $78.82 $4.04

Voluntary Rates (Monthly)
Critical
Life and AD&D Long Term Disability Illness Accident ID Theft

Employee Spouse Child(ren) Rate Based off Enrollment Benefit
Age Per $1,000 Per $1,000 Per $1,000 Age Per $100 Age, Benefit Tier Elite
(as of 9/1) of Coverage of Coverage of Coverage (as of 9/1) of Payroll Amount, and
Tobacco User

<30 $0.065 $0.065 $0.200 <30 $0.080
30-34 $0.065 $0.065 30-34 $0.160
35-39 $0.087 $0.087 35-39 $0.298
40-44 $0.122 $0.122 40-44 $0.430 See Ease EE: $16.52 EE: $8.49
45-49 $0.185 $0.185 45-49 $0.623 Central for ES: $25.58
50-54 $0.282 $0.282 50-54 $0.885 you and your EC: $22.53 EE+Dep:
55-59 $0.489 $0.489 55-59 $1.112 family’s EF:$32.33 $16.98
60-64 $0.690 $0.690 60-64 $1.100 specific rate
65-69 $1.190 $1.190 65-69 $0.986
70-74 $2.000 $2.000 70-74 $1.642
75+ $7.590 $7.590 75+ $2.350
AD&D $0.020 $0.020 $0.040

Premium Calculators
Voluntary Life and AD&D Premium Calculator

Employee Spouse Child(ren)

Election amount A A A
Divided by 1,000 B B B
Multiplied by rate from chart (add $0.02 if electing employee or spouse AD&D C C C
and $0.04 if electing child AD&D)
Divided by 2 - This is your estimated post-tax payroll deduction $ $ $
Voluntary Long Term Disability Premium Calculator

Employee
Average MONTHLY earnings (not to exceed $16,667) A

Divide rate from chart by 100 B
Multiply box A by box B C
Divided by 2 - This is your estimated post-tax payroll deduction $
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