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Employee Health Plan Contributions 11
ABC Company pays the majority of health plan premium costs for employees. Your monthly contributions
are divided between your semi-monthly paychecks and are deducted on a pre-tax basis.
Employee Cost Sharing for Monthly Medical Plan Contributions
Employee
Coverage Employee Plus Spouse/ Employee Employee
Plus
Plus
for Only Domestic Child(ren) Family
Partner
Medical Plans – California
Anthem Blue Cross Lumenos HSA Plan $126.00 $280.00 $260.00 $400.00
Anthem Blue Cross Classic HMO Plan $205.00 $400.00 $370.00 $580.00
Anthem Blue Cross Premier PPO Plan $180.00 $400.00 $340.00 $600.00
Kaiser Permanente HMO Plan $120.00 $260.00 $240.00 $360.00
Kaiser Permanente HSA Deductible HMO Plan $90.00 $200.00 $180.00 $310.00
Medical Plans – Outside California
Anthem Blue Cross Lumenos HSA Plan $126.00 $280.00 $260.00 $400.00
Anthem Blue Cross Premier PPO Plan $180.00 $400.00 $340.00 $600.00
Anthem Blue Cross Exclusive Classic (EPO) Plan $150.00 $360.00 $300.00 $500.00
Employee Cost Sharing for Monthly Dental and Vision
Plan Contributions
Employee
Employee
Coverage Employee Plus Two
for Only Plus One or More
Dependent
Dependents
MetLife Dental Plan $12.00 $24.00 $46.00
Vision Service Plan (VSP): Paid 100% by ABC Company for you and your enrolled eligible dependents
