Page 11 - Kagan Benefit Guide Out of CA.pub

Team Member Contributions

This chart compares the monthly and per paycheck contribu ons for our Team member Benefit plans. Your cost for coverage will
vary depending on the op on and level of coverage you choose. For your convenience, your age‐banded Supplemental Life and
AD&D and Voluntary Short Term Disability premiums have been pre‐calculated for you in Ease.

Monthly Per Paycheck
Team member Cost Team member Cost

Medical Classic PPO - Anthem Blue Cross
Team member Only $166.99 $83.49
Team member + Spouse $617.84 $308.92
Team member + Child(ren) $467.56 $233.78
Team member + Family $955.98 $477.99
Dental PPO - Principal Financial
Team member Only $14.57 $7.29
Team member + Spouse $47.69 $23.85
Team member + Child(ren) $51.62 $25.81
Team member + Family $89.09 $44.54
Vision - Anthem Blue Cross

Team member Only $1.57 $0.79
Team member + Spouse $4.05 $2.03
Team member + Child(ren) $4.41 $2.21
Team member + Family $7.59 $3.80
Basic Life and AD&D - Principal Financial and Anthem Blue Cross
Team member Only No Charge No Charge
Voluntary Life and AD&D / Voluntary Short and Long Term Disability - Unum

Team member Only 100% ‐ Please refer to Ease 100% ‐ Please refer to Ease
Team member + Spouse 100% ‐ Please refer to Ease 100% ‐ Please refer to Ease
Team member + Child(ren) 100% ‐ Please refer to Ease 100% ‐ Please refer to Ease

Team member Assistance Program - Unum

Team member + Family No Charge No Charge

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