Page 10 - BBM I Broch 2017-18

Associate Contributions

Note regarding medical, dental and vision contributions:
Associate contributions for medical, dental and vision are listed below by monthly amount (divide by two for per pay period
amounts). These particular contributions are deducted from paychecks with pre-tax dollars. This results in lower taxes and
increased take home pay.

Find your state category MEDICAL/DENTAL/VISION
for CATEGORY 1 DISABILITY & LIFE
Medial/Dental/Vision
Medical HMO / DHMO / Vision Supplemental Life
Associate Age Rate Per $1,000
CATEGORY 1 Single $99
AZ Two-Party $378 <25 $0.057
CA Family $616
CO 25-29 $0.068
Medical HMO / DPPO / Vision
CT
30-34 $0.079
FL Single $99
GA Two-Party $438 35-39 $0.102
IL Family $676
IN 40-44 $0.131
KS Medical PPO / DHMO / Vision 45-49 $0.197
NC
Single $298 50-54 $0.302
NJ Two-Party $680
SC Family $1,008 55-59 $0.565
TN
TX Medical PPO / DPPO / Vision 60-64 $0.866

CATEGORY 2 Single $298 65-69 $1.667
AL Two-Party $746 70+ $2.704
AR Family $1,074
DE Buy-Up Long Term Disability
IA MEDICAL/DENTAL/VISION
KY CATEGORIES 2 & 3 $0.26 per $100 of monthly coverage
LA
MA Medical PPO / DHMO / Vision - Cat. 2
Voluntary Short Term Disability
MD Medical PPO / DPPO / Vision - Cat. 2 & 3
MI Associate Rate Per $10 weekly
MN Single $204 Age Benefit
MO Two-Party $626
$970
Family
MS CA, HI, NJ, RI, Puerto Rico
NE
NV Under 50 $0.369
NY DENTAL/VISION ONLY 50-54 $0.37
OH
OK Dental DHMO & Vision—Categories 1 & 2 55-59 $0.453
OR 60-64 $0.534
PA Single $17 65 and over $0.586
UT
Two-Party $44
VA
Family $75 All Other States
WI
Under 50 $0.423
CATEGORY 3 Dental PPO & Vision—All Categories
50-54 $0.424
Any state not listed in
Categories 1 or 2 Single $52 55-59 $0.519
Two-Party $120
60-64 $0.612
Family $160
65 and over $0.671
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