Page 6 - Veritone EE Guide OOS_ 2019

Your cost per month

Medical Options Option 1 Option 2 Option 3 IRS CODE Section 125
The Veritone employee benefit plans
Plan PPO $500 PPO $1,500 HSA PPO are designed under Section 125 of the
Employee Only $136.91 $107.25 $79.35 IRS Code. This allows you to take
Employee + Spouse $301.20 $235.94 $174.79 advantage of federal laws by
Employee + Child(ren) $246.44 $193.05 $142.83 purchasing some of your benefits with
Employee + Family $424.41 $332.47 $246.00 pre-tax dollars. Under Section 125,
your Medical, Dental, Vision, and
Dental Options Option 1 Option 2 Flexible Spending Account

Plan PPO High PPO Low contributions are deducted before taxes
are withheld which saves you tax
Employee Only $14.04 $7.36 dollars. Paying for benefits before-tax
Employee + Spouse $28.47 $16.05 means that your share of the costs is
Employee + Child(ren) $31.74 $15.47 deducted before taxes are determined,
Employee + Family $45.01 $22.31 resulting in more take-home pay for
you. As a result, the IRS requires that
Vision Option
your elections remain in effect for the
Plan PPO entire year. You cannot drop or change
coverage unless you experience a
Employee Only $1.37
Employee + Spouse $2.74 qualifying event. You may waive
Employee + Child(ren) $2.80 participation in the Section 125 Plan
Employee + Family $4.17 and elect to pay all contributions with
after-tax dollars. Contact the Human
Resources Department if you wish to
pay for your benefits with after-tax
For your convenience, your age-banded Voluntary Life/AD&D premiums have dollars.

been pre-calculated for you in Paycom.