Page 15 - JFSLA - Benefits Guide 2018-2019 (5.29.18)

Employee Contributions

This chart compares the monthly contributions for our Employee Benefit plans. Your cost for coverage will vary depending on the
option and level of coverage you choose.

Monthly Bi-Weekly
Employee Rate Employee Rate

Medical—Vivity Classic HMO
Employee Only $39.47 $18.22
Employee + 1 $842.63 $388.91
Employee + 2 or more $1499.74 $692.19

Medical—Classic HMO

Employee Only $169.98 $78.45
Employee + Spouse $1,116.68 $515.39
Employee + Child(ren) $1,891.25 $872.89

Medical—PPO HSA 2700/20

Employee Only $326.64 $150.76
Employee + Spouse $1,445.67 $667.23
Employee + Child(ren) $2,361.25 $1,089.81

Medical—Classic PPO
Employee Only $758.62 $350.13
Employee + Spouse $2,352.84 $1,085.93
Employee + Child(ren) $3,657.18 $1,687.93

Dental HMO
Employee Only $0.00 $0.00
Employee + Spouse $18.51 $8.54
Employee + Child(ren) $41.65 $19.22

Dental PPO
Employee Only $39.34 $18.16
Employee + Spouse $102.08 $47.11
Employee + Child(ren) $175.55 $81.02

Basic Life and AD&D - Anthem
Employee Only 0%

Voluntary Life and AD&D - Anthem
Employee Only 100%
Spouse Only 100%
Child(ren) Only 100%
Long Term Disability - UNUM

Employee Only 0%

*Please note that these charts compare the per-paycheck and monthly contributions for our Employee Benefit plans. Your cost for
coverage will vary depending on the option and level of coverage you choose.

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