Page 5 - Hitachi Benefits Booklet Final

Your cost per paycheck

IRS CODE Section 125
The Hitachi Solutions Employee Benefit plans are designed under Section 125 of the IRS Code. This allows you to take
advantage of federal laws by purchasing some of your benefits with pre-tax dollars. Under Section 125, your Medical,
Dental, Vision, and Flexible Spending and Health Savings Account contributions are deducted before taxes are withheld
which saves you tax dollars. Paying for benefits before-tax means that your share of the costs is deducted before taxes
are determined, resulting in more take-home pay for you. As a result, the IRS requires that your elections remain in
effect for the entire year. You cannot drop or change coverage unless you experience a qualifying event. You may waive
participation in the Section 125 Plan and elect to pay all contributions with after-tax dollars. Contact the Human Re-
sources Department if you wish to pay for your benefits with after-tax dollars.

Medical Options

Aetna
Kaiser HMO Aetna HMO Aetna High Aetna Silver Aetna Gold Platinum
Deductible
(CA Only) (CA Only) PPO PPO
Plan HSA PPO
Employee Only $24.00 $35.00 $30.00 $57.00 $86.00 $234.00
Employee + Spouse $66.00 $109.00 $90.00 $211.00 $259.00 $520.00
Employee + Child(ren) $60.00 $93.00 $74.00 $160.00 $201.00 $490.00
Employee + Family $120.00 $195.00 $167.00 $320.00 $386.00 $777.00

Dental Options

Delta Dental LifeLock Identity Theft Plans
Plan PPO Benefit Elite Ultimate Plus
Employee Only $8.00
Employee + One Dependent $17.00 Employee Only $2.99 $10.99
Employee + Family $30.00 Employee + 1 or More Dependents $6.99 $22.99

Vision Option

Plan EyeMed PPO Cigna Voluntary Life and AD&D
Semi-Monthly Rate / $1,000 of Benefit for EE or SP*

Employee Only $1.00 Under 25 $0.025 45-49 $0.112
Employee + One Dependent $2.00
Employee + Family $5.00 25-29 $0.030 50-54 $0.193
30-34 $0.040 55-59 $0.327
Voluntary Life & Short Term Disability 35-39 $0.045 60-64 $0.500
Rates are based on your age and your salary or benefit. 40-44 $0.066 64+ $0.782
For your convenience, the costs are calculated for you on
the Sterling Online System. Cigna Child(ren) Life Only
Semi-Monthly Rate per $0.90 for $10,000 benefit
Cigna Voluntary Short Term Disability Child(ren)
Semi-Monthly Rate / $10 of weekly benefit
Under 50 $0.025 60-64 $0.112 *Voluntary Life rates based on employee’s age at initial entry
and thereafter age as of January 1. Spouse’s age is based on
50-54 $0.030 65-99 $0.193 employee’s age. Rounding: Life and Disability plans are pre-
55-59 $0.040 calculated for your on the Sterling Online System. Manual
calculations may have rounding differences.