Page 6 - Veritone EE Guide 07-19

Your cost per month

IRS CODE Section 125
Medical Options Option 1 Option 2 Option 3 Option 4 Option 5 The Veritone employee benefit plans

Plan Kaiser HMO Anthem HMO PPO $500 PPO $1,500 HSA PPO are designed under Section 125 of
the IRS Code. This allows you to take
Employee Only $78.91 $87.25 $136.91 $107.25 $79.35 advantage of federal laws by
Employee + Spouse $182.28 $191.93 $301.20 $235.94 $174.79 purchasing some of your benefits
Employee + Child(ren) $160.97 $157.04 $246.44 $193.05 $142.83 with pre-tax dollars. Under Section
Employee + Family $239.09 $270.45 $424.41 $332.47 $246.00 125, your Medical, Dental, Vision,

Dental Options Option 1 Option 2 and Flexible Spending Account
contributions are deducted before
Plan PPO High PPO Low taxes are withheld which saves you
Employee Only $14.04 $7.36 tax dollars. Paying for benefits before
Employee + Spouse $28.47 $16.05 -tax means that your share of the
Employee + Child(ren) $31.74 $15.47 costs is deducted before taxes are
Employee + Family $45.01 $22.31 determined, resulting in more take-
home pay for you. As a result, the
Vision Option IRS requires that your elections
remain in effect for the entire year.
Plan PPO You cannot drop or change coverage

Employee Only $1.37 unless you experience a qualifying
Employee + Spouse $2.74 event. You may waive participation in
Employee + Child(ren) $2.80 the Section 125 Plan and elect to pay
Employee + Family $4.17 all contributions with after-tax dollars.
Contact the Human Resources
Department if you wish to pay for

For your convenience, your age-banded Voluntary Life/AD&D premiums your benefits with after-tax dollars.

have been pre-calculated for you in Paycom.