Page 10 - Coast Sign Benefit Summary 2017 Final 9.26.17

Rates and Contributions

This chart compares the weekly contributions for our employee benefit plans. Your cost for coverage
will vary depending on the option and level of coverage you choose.
Weekly Employee Rate
Medical Select / SIMNSA HMO - Anthem

Employee Only $20.76
Employee + Spouse $114.16
Employee + Child(ren) $82.19
Employee + Family $152.82

NOTES: Medical HMO - Kaiser
Employee Employee Only $33.56
contributions for Employee + Spouse $150.46
Medical, Dental and
Vision are deducted Employee + Child(ren) $103.83
from your paycheck Employee + Family $198.04
with pre-tax dollars. Medical HMO - Anthem
This means that
contributions are Employee Only $54.39
taken from your
Employee + Spouse $209.41
earnings before
Employee + Child(ren) $146.86
taxes – resulting in
lower taxes and Employee + Family $274.00
increased take home Medical PPO - Anthem
pay.
Employee Only $103.10
Employee + Spouse $302.41
Employee + Child(ren) $231.96
If you are enrolling
Employee + Family $436.78
dependents onto
your plan(s) you Dental DHMO - Premier Access
must provide legal
Employee Only $1.30
proof with your
enrollment form (i.e. Employee + Spouse $1.96
marriage certificate Employee + Child(ren) $3.60
for enrolling spouses, Employee + Family $6.01
and/or birth
certificates for Dental PPO - Premier Access
enrolling children).
Employee Only $6.56
Employee + Spouse $12.29
Employee + Child(ren) $15.72
Employee + Family $25.66
Vision - EyeMed

Employee Only $1.27
Employee + 1 $2.41
Employee + Family $3.54

Basic Life and AD&D - Anthem
Employee Only Paid by Coast Sign
Voluntary Coverages / (Long Term Disability, Accident, Critical Illness)

Employee Only 100%
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