Page 5 - Sumitomo EE Guide 06-18.pub

EMPLOYEE CONTRIBUTIONS

This chart compares the contribu ons for our Employee Benefit plans. Your cost for coverage will vary depending on the op on
and level of coverage you choose. Employee contribu ons for Medical, Dental, and Vision are deducted from your paycheck with
pre‐tax dollars.

Note: Dental and vision plans are bundled. If dental is elected, vision will also be included.

MEDICAL BLUE SHIELD BLUE SHIELD The following benefits are
HMO MEDICAL PPO MEDICAL provided to you at no
Semi-Monthly California California Non-California charge and are paid by
Employee Only $36.18 $47.85 $53.01 SRNA:
Employee + Spouse $79.59 $105.26 $116.62  Basic Life and AD&D
Employee + Child(ren) $65.12 $86.12 $95.42  Business Travel Accident
Employee + Family $112.15 $148.33 $164.33  Travel Assistance Program
Bi-Weekly California California Non-California  Short Term Disability
Employee Only $33.39 $44.16 $48.93  Long Term Disability
Employee + Spouse $73.46 $97.16 $107.64  Employee Assistance Program
Employee + Child(ren) $60.11 $79.49 $88.08  Health Advocate
Employee + Family $103.52 $136.92 $151.68  Value‐Added Programs

DENTAL & VISION METLIFE VSP The following benefits are
DENTAL VISION
available to you at discount-
Semi-Monthly All Areas All Areas ed group rates. Should you
Employee Only $4.74 $0.97 elect these benefits, you will
Employee + Spouse $9.39 $1.58
Employee + Child(ren) $11.28 $1.61 pay 100% of the cost:
Employee + Family $17.42 $2.51  Supplemental Life and AD&D
 Flexible Spending Account
Bi-Weekly All Areas All Areas Contribu ons
Employee Only $4.38 $0.90  Voluntary Benefits
Employee + Spouse $8.66 $1.45
Employee + Child(ren) $10.41 $1.48
Employee + Family $16.08 $2.32

Note: For your convenience, your age‐banded Supplemental Life and AD&D and premiums have been pre‐calculated for you in
Paycom.
SUPPLEMENTAL LIFE SUPPLEMENTAL AD&D

Monthly Contributions Per $1,000 of Benefit Monthly Contributions Per $1,000 of Benefit
Employee/Spouse* Employee Only
Age Under 30 $0.06 All Ages $0.024
30 ‐ 34 $0.07
35 ‐ 39 $0.09  The benefit amount is
40 ‐ 44 $0.15 the same as the
45 ‐ 49 $0.23 Supplemental Life
50 ‐ 54 $0.36 amount
55 ‐ 59 $0.58  Automa cally provided
60 ‐ 64 $0.83 to employees who elect
65 ‐ 69 $1.45 Supplemental Life
70 + $3.21  AD&D is not available
for Spouse and Children
Children $0.20
*Spouse’s rates is based on employee’s age
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