Page 23 - Rauxa EE Guide 04-18 CA

Employee Contributions

This chart compares the semi-monthly contributions for our employee benefit plans. Your cost for coverage will vary
depending on the option and level of coverage you choose. For your convenience, your age-banded Voluntary Life and
AD&D premiums have been pre-calculated for you in Paylocity.

1 Member 2 Members No Wellness
Wellness Participation Wellness Participation Participation
Rauxa Pays You Pay Rauxa Pays You Pay Rauxa Pays You Pay
MEDICAL
HMO
Employee Only $287.63 $0.00 N/A N/A $257.63 $30.00
Employee + Spouse $338.32 $294.48 $368.32 $264.48 $308.32 $324.48
Employee + Child(ren) $368.32 $149.43 N/A N/A $338.32 $179.43
Employee + Family $338.32 $553.35 $368.32 $523.35 $308.32 $583.35
HSA
Employee Only $287.37 $0.00 N/A N/A $257.37 $30.00
Employee + Spouse $338.32 $293.91 $368.32 $263.91 $308.32 $323.91
Employee + Child(ren) $368.32 $148.96 N/A N/A $338.32 $178.96
Employee + Family $338.32 $552.54 $368.32 $522.54 $308.32 $582.54
PPO Low
Employee Only $368.32 $0.00 N/A N/A $338.32 $30.00
Employee + Spouse $338.32 $471.98 $368.32 $441.98 $308.32 $501.98
Employee + Child(ren) $368.32 $294.65 N/A N/A $338.32 $324.65
Employee + Family $338.32 $803.46 $368.32 $773.46 $308.32 $833.46
PPO High
Employee Only $368.32 $52.06 N/A N/A $338.32 $82.06
Employee + Spouse $338.32 $586.50 $368.32 $556.50 $308.32 $616.50
Employee + Child(ren) $368.32 $388.35 N/A N/A $338.32 $418.35
Employee + Family $338.32 $964.83 $368.32 $934.83 $308.32 $994.83

Rauxa Pays You Pay
DENTAL
DHMO
Employee Only $7.19 $0.00
Employee + Spouse $7.19 $6.91
Employee + Child(ren) $7.19 $7.64
Employee + Family $7.19 $14.84
PPO
Employee Only $7.19 $25.92
Employee + Spouse $7.19 $58.48
Employee + Child(ren) $7.19 $70.06
Employee + Family $7.19 $103.20
VISION
Employee Only $5.01 $0.00
Employee + Spouse $5.01 $4.01
Employee + Child(ren) $5.01 $3.83
Employee + Family $5.01 $7.92

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