Page 16 - 360 Behavioral Health Guide 2018-2019 Final

Employee Contributions

This chart shows the per paycheck contributions for our Employee Benefit plans. 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. For your convenience, your age-banded
Supplemental Life and AD&D premiums have been pre-calculated for you in EaseCentral.

Semi-Monthly Deduction
Anthem Blue Cross Classic HMO (Select) - CA Only
− Employee $91.14
− Employee + Spouse $309.86
− Employee + Child(ren) $236.95
− Employee + Family $473.91
Anthem Blue Cross Classic HMO (Traditional) - CA Only
− Employee $156.08
− Employee + Spouse $452.74
− Employee + Child(ren) $353.86
− Employee + Family $675.24
Kaiser Permanente HMO - CA Only
− Employee $145.50
− Employee + Spouse $429.45
− Employee + Child(ren) $382.13
− Employee + Family $618.76

Anthem Blue Cross Classic PPO
− Employee $191.89
− Employee + Spouse $566.86
− Employee + Child(ren) $441.87
− Employee + Family $848.09
Anthem Blue Cross Solutions PPO
− Employee $120.59
− Employee + Spouse $410.00
− Employee + Child(ren) $313.53
− Employee + Family $627.06
Anthem Blue Cross PPO HSA
− Employee $88.65
− Employee + Spouse $339.73
− Employee + Child(ren) $256.04
− Employee + Family $528.05

MetLife DHMO Dental - CA Only
− Employee $6.92
− Employee + Spouse $13.15
− Employee + Child(ren) $13.85
− Employee + Family $19.81
MetLife DPPO Dental
− Employee $24.49
− Employee + Spouse $48.71
− Employee + Child(ren) $58.09
− Employee + Family $88.55

Eyemed Vision
$4.99
− Employee $9.48
− Employee + 1 $13.91
− Employee + 2 or more

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