Page 18 - Surfline Benefits Guide 2017

Employee Contributions

This chart compares the per-paycheck contributions for our employee benefit plans. Your cost for coverage will vary depending on the option
and level of coverage you choose. For your convenience, your age-banded dependent Medical and Voluntary Life and AD&D premiums have
been pre-calculated for you in EaseCentral.

Employee Cost Per Paycheck (Semi-Monthly)
MEDICAL
Platinum HMO Silver PPO HSA Gold PPO Platinum PPO*
Employee Only $0.00 $0.00 $0.00 Buy-Up
Employee + Spouse See EaseCentral See EaseCentral See EaseCentral See EaseCentral
Employee + Child(ren) for Age-Specific for Age-Specific for Age-Specific for Age-Specific
Employee + Family Rates for Dependents Rates for Dependents Rates for Dependents Rates for Dependents
DENTAL

Dental PPO
Employee Only $0.00
Employee + Spouse $21.76
Employee + Child(ren) $30.09
Employee + Family $52.07
VISION
Employee Only $0.00
Employee + 1 Dependent $3.06
Employee + 2 or More Dependents $8.10
*The Platinum PPO is offered as a Buy-Up option from the Gold PPO

The following benefits are provided to you at no charge and are paid by Surfline/Wavetrak, Inc.:
• Employee Assistance Program
• Basic Life/AD&D
• Long Term Disability

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/AD&D (rates pre-calculated in EaseCentral)
• Pet Insurance (contact United Pet Care for rates)
• Supplemental Benefits - Accident, Critical Illness, and Hospital

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