Page 15 - Rampart EE Guide 01-20.pub

EMPLOYEE CONTRIBUTIONS

This chart compares the weekly and biweekly 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. This means that contribu ons are taken from your earnings before taxes, resul ng in
lower taxes and increased take home pay.

Medical Cigna
OAP with HRA

Weekly Biweekly
Employee Only $20.00 $40.00
Employee + Spouse $40.00 $80.00
Employee + Child(ren) $31.00 $62.00
Employee + Family $55.00 $110.00
Dental Cigna
Dental PPO

Weekly Biweekly
Employee Only $7.92 $15.84
Employee + Spouse $15.63 $31.27
Employee + Child(ren) $19.37 $38.74
Employee + Family $29.79 $59.58
Vision Cigna
Vision
Weekly Biweekly
Employee Only $1.53 $3.06
Employee + Spouse $3.06 $6.12
Employee + Child(ren) $3.09 $6.18
Employee + Family $4.93 $9.86
Legal & Identity Theft LegalShield/IDShield

LegalShield Only: Weekly Biweekly
Employee Only $4.37 $8.75
Family $4.37 $8.75
IDShield Only:
Employee Only $2.07 $4.13
Family $4.37 $8.75
Combined (Legal & ID):
Employee Only $6.44 $12.88
Family $7.82 $15.65

The following benefits are provided to you at no charge and are paid by Rampart Supply:
 Basic Life/AD&D — eligible a er 1 year of employment
 Short Term Disability — eligible a er 1 year of employment
 Long Term Disability — eligible a er 1 year of employment
 Long Term Care — eligible if employed at least 6 months prior to open enrollment

The following benefits are available to you at discounted group rates.
Should you elect these benefits, you will pay 100% of the cost:
 Dental — eligible 1st of the month following 30 days
 Vision — eligible 1st of the month following 30 days
 Legal — eligible 1st of the month following 30 days
 ID The Plans — eligible 1st of the month following 30 days
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