Page 10 - BB Dakota Benefit Summary 12-2017.pub

Employee Contributions

This chart compares the per paycheck 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.

Per Paycheck
Employee Cost
Medical HMO - Blue Shield

Employee Only Employee covered at 100%
Employee + Spouse See Ease Central for
Employee + Child(ren) Dependent Age‐Specific
Employee + Family Rates
Medical PPO - Blue Shield

Employee Only See Ease Central for Employee
Employee + Spouse and Dependent Age‐Specific
Employee + Child(ren) Rates
Employee + Family
Dental HMO - Delta Dental

Employee Only $0.00
Employee + 1 $6.60
Employee + 2 or more $13.74
Dental PPO - Delta Dental

Employee Only $9.83
Employee + 1 $28.46
Employee + 2 or more $55.94
Vision - EyeMed

Employee Only $3.71
Employee + 1 $7.02
Employee + 2 or more $10.31
Basic Life and AD&D - Anthem Blue Cross

Employee Only Paid by BB Dakota
Employee Assistance Program - Anthem Blue Cross
Employee + Family Paid by BB Dakota

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