Page 17 - Burnham Benefits Guide 2017

EMPLOYEE CONTRIBUTIONS

These charts compare 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. Burnham contributes 85% of the employee premiums and
50% of the dependent premiums for Medical, Dental and Vision. EaseCentral and the tables below illustrate the employee
contributions after Burnham’s contributions have been subtracted.

MEDICAL OPTIONS
Kaiser Permanente - Platinum 0/15 HMO UnitedHealthcare - Signature 20-40/70% HMO

Employee Only Employee Only
Employee + Spouse Employee + Spouse
Refer to EaseCentral Refer to EaseCentral
Employee + Child(ren) Employee + Child(ren)
Employee + Family Employee + Family

UnitedHealthcare - Select Plus 20/750/20% PPO UnitedHealthcare - Select Plus 2000/80% HSA
Employee Only Employee Only
Employee + Spouse Employee + Spouse
Refer to EaseCentral Refer to EaseCentral
Employee + Child(ren) Employee + Child(ren)
Employee + Family Employee + Family

DENTAL VISION
Guardian PPO Guardian/VSP

Employee Only $4.39 Employee Only $0.77
Employee + Spouse $20.58 Employee + Spouse $2.51
Employee + Child(ren) $23.81 Employee + Child(ren) $2.59
Employee + Family $40.42 Employee + Family $5.14

EMPLOYER -PAID BENEFITS EMPLOYEE-PAID BENEFITS
Employee Assistance Program Voluntary Life and AD&D

Employee + Household Paid by Burnham Employee + Dependents See EaseCentral

Basic Life and AD&D Voluntary Short Term Disability

Employee Only Paid by Burnham Employee Only See EaseCentral

Long Term Disability Commuter Benefit Program
Employee Only Varies Employee Only Employee Determined

Travel Assistance
Employee Only Paid by Burnham

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