Page 19 - Community Health Systems Guide 2018-FINAL

Employee Contributions

Health Benefit Contributions

This chart compares the monthly and 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.

CHSI Monthly Premiums Your Monthly Contribution Your Per Period Deduction

Anthem HMO Medical
 Employee $631.82 $0.00 $0.00
 Employee + Spouse $1389.99 $758.17 $379.09
 Employee + Child(ren) $1137.26 $505.44 $252.72
 Employee + Family $1958.62 $1326.80 $663.40

Anthem HSA Medical
 Employee $655.20 $23.38 $11.69
 Employee + Spouse $1441.43 $809.61 $404.81
 Employee + Child(ren) $1179.35 $547.53 $273.77
 Employee + Family $2031.11 $1399.29 $699.65
Anthem PPO Medical
 Employee $892.61 $260.79 $130.40
 Employee + Spouse $1963.75 $1331.93 $665.97
 Employee + Child(ren) $1606.71 $974.89 $487.45
 Employee + Family $2767.11 $2135.29 $1067.65

Anthem DHMO Dental
 Employee $14.99 $0.00 $0.00
 Employee + Spouse $29.98 $14.99 $7.50
 Employee + Child(ren) $29.98 $14.99 $7.50
 Employee + Family $48.72 $33.73 $16.87
Anthem DPPO Dental
 Employee $38.40 $23.41 $11.71
 Employee + Spouse $67.53 $52.54 $26.27
 Employee + Child(ren) $97.98 $82.99 $41.50
 Employee + Family $137.42 $122.43 $61.22
Anthem Blue View Vision
 Employee $6.60 $1.65 $0.83
 Employee + Spouse $13.53 $8.58 $4.29
 Employee + Child(ren) $13.20 $8.25 $4.13
 Employee + Family $20.13 $15.18 $7.59

Contributions for Other Benefits
The following benefits are provided to you at no charge and are paid by CHSI:
• Employee Assistance Program
• Basic Life and AD&D
• Long Term Disability

Colonial Worksite Benefits are 100% voluntary and 100% employee paid.

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