Page 5 - Sumitomo EE Guide 06-20 Final English
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EMPLOYEE CONTRIBUTIONS
This chart compares the contributions for our Employee Benefit plans. Your cost for coverage will vary depending on the option
and level of coverage you choose. Employee contributions for Medical, Dental, and Vision are deducted from your paycheck with
pre-tax dollars.
Note: Dental and vision plans are bundled. If dental is elected, vision will also be included.
MEDICAL BLUE SHIELD BLUE SHIELD The following benefits are
HMO MEDICAL PPO MEDICAL provided to you at no
Semi-Monthly California California Non-California charge and are paid by
Employee Only $36.95 $64.29 $69.29 SRNA:
Employee + Spouse $81.29 $141.44 $152.44 • Basic Life and AD&D
Employee + Child(ren) $66.51 $115.72 $124.72 • Business Travel Accident
Employee + Family $114.55 $199.32 $214.80 • Travel Assistance Program
• Short Term Disability
Bi-Weekly California California Non-California
Employee Only $34.11 $59.34 $63.96 • Long Term Disability
Employee + Spouse $75.03 $130.56 $140.71 • Employee Assistance Program
Employee + Child(ren) 61.39 $106.82 $115.13 • Health Advocate
Employee + Family $105.73 $183.98 $198.27 • Value-Added Programs
DENTAL & VISION METLIFE VSP The following benefits are
DENTAL VISION available to you at discount-
Semi-Monthly All Areas All Areas ed group rates. Should you
Employee Only $4.74 $0.97 elect these benefits, you will
Employee + Spouse $9.39 $1.57 pay 100% of the cost:
Employee + Child(ren) $11.28 $1.60 •
Employee + Family $17.42 $2.51 Supplemental Life and AD&D
• Flexible Spending Account
Bi-Weekly All Areas All Areas Contributions
Employee Only $4.38 $0.90 • Voluntary Benefits
Employee + Spouse $8.66 $1.44
Employee + Child(ren) $10.41 $1.47
Employee + Family $16.08 $2.31
Note: For your convenience, your age-banded Supplemental Life and AD&D premiums have been calculated for you in Paycom.
SUPPLEMENTAL LIFE MONTHLY RATE PER $1,000 OF BENEFIT PREMIUM CALCULATION EXAMPLES
Employee/Spouse* Employee Benefit = $100,000
Spouse Benefit = $50,000
Age Under 30 $0.06 Children Benefit = $25,000
30 - 34 $0.07
35 - 39 $0.09 • Employee Coverage Age = 32
40 - 44 $0.15 Life: $100,000 ÷ $1,000 × $0.07 =
45 - 49 $0.23 $7.00 per month
50 - 54 $0.36 AD&D: $100,000 ÷ $1,000 × $0.024 =
55 - 59 $0.58 $2.40 per month
60 - 64 $0.83 • Spouse Coverage Age = 32 (always use
65 - 69 $1.45 employee’s age)
70 + $3.21 Life: $50,000 ÷ $1,000 × $0.07 =
$3.50 per month
Children $0.20
• Child Coverage (covers all eligible
SUPPLEMENTAL AD&D MONTHLY RATE PER $1,000 OF BENEFIT dependent children under age 26)
Life: $25,000 ÷ $1,000 × $0.20 =
All Ages—Employee Only $0.024
$5.00 per month
*Spouse’s rate is based on employee’s age
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