Page 18 - Evisions Benefit Guide 2020 - Effective 1.1.2020

Employee Contributions

This chart compares the semi-monthly (per pay period) contributions for our Employee Benefit plans. Spouse can also refer to
Domestic Partner. Your cost for coverage will vary depending on the option and level of coverage you choose. 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 Voluntary Life and AD&D premiums have been pre-calculated for you in Maxwell.

Medical Kaiser Blue Shield Blue Shield
HMO Network Trio ACO HMO Access+ HMO
Limited Network Full Network
(Available to CA (Available to CA (Available to CA
Employees Only) Employees Only) Employees Only)

Employee Only $40 $40 $111.90
Employee + Spouse $179.38 $178.80 $336.97
Employee + Child(ren) $146.76 $146.29 $275.70
Employee + Family $252.77 $251.94 $474.80
Medical Blue Shield Blue Shield
HDHP/HSA PPO
Employee Only $10 $123.40
Employee + Spouse $188.27 $437.73
Employee + Child(ren) $154.04 $358.15
Employee + Family $265.29 $616.81
Dental Blue Shield
PPO
Employee Only $0
Employee + Spouse $24.11
Employee + Child(ren) $35.33
Employee + Family $59.44
Vision UNUM—EyeMed
PPO

Employee Only $0
Employee + Spouse $2.60
Employee + Child(ren) $2.71
Employee + Family $6.48

The following benefits are provided to you at no charge and are paid by Evisions:
• Basic Life and AD&D
• Group Short Term Disability (NonCA employees only)
• Employee Assistance Program

The following benefits are available to you at discounted group rates. Should you elect these benefits, you will
pay 100% of the cost:
• Voluntary Life and AD&D
• Voluntary Short Term Disability (CA employees only)
• Voluntary Long Term Disability
• Pet Discount Program
• Accident Insurance

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