Page 10 - CA Benefit Guide Shepard Bros 8-17

EMPLOYEE CONTRIBUTIONS

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

Employee Per Paycheck Employee Per Paycheck
Rate with Wellness Credit Rate without Wellness
Credit
Medical HMO - Anthem Blue Cross

Employee Only $38.74 $48.74
Note Employee + Spouse $136.58 $156.58
$121.75
$111.75
Employee + Child(ren)
Employee Employee + Family $192.45 $212.45
contributions for
Medical, Dental and
Vision are deducted Medical PPO - Anthem Blue Cross
from your paycheck
with pre-tax dollars. Employee Only $55.85 $65.85
This means that Employee + Spouse $182.33 $202.33
contributions are Employee + Child(ren) $149.18 $159.18
taken from your Employee + Family $256.92 $276.92
earnings before
taxes - resulting in Dental HMO - Anthem Blue Cross
lower taxes and
increased take home Employee Only $1.14
pay.
Employee + Spouse $2.28
Employee + Child(ren) $2.28
Employee + Family $3.70

Dental PPO - Anthem Blue Cross

Employee Only $3.47
Employee + Spouse $7.06
Employee + Child(ren) $7.87
Employee + Family $11.92

Vision - Anthem Blue Cross

Employee Only $0.64
Employee + Spouse $1.09
Employee + Child(ren) $1.15
Employee + Family $1.73

Basic Life and AD&D - Anthem Blue Cross

No Charge

Employee Assistance Program / Long Term Disability -
Mutual of Omaha

Employee + Family No Charge

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