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Employee Contributions

Health Benefits

This chart compares the monthly and per paycheck contribu ons for our Employee 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 Voluntary Life and AD&D

Monthly Premium Firm Pays Employee Pays

Medical
MEDICAL: Aetna HMO
Employee Only $567.95 $567.95 $0.00
Employee + Spouse $1,204.05 $567.95 $626.10
Employee + Child(ren) $1,107.50 $567.95 $539.55
Family $1,729.41 $567.95 $1,161.46
MEDICAL: Aetna PPO
Employee Only $679.63 $577.69 $101.94
Employee + Spouse $1,440.82 $577.69 $863.13
Employee + Child(ren) $1,325.28 $577.69 $747.59
Family $2,069.47 $577.69 $1,491.78
MEDICAL: Aetna HSA
Employee Only $567.08 $567.08 $0.00
Employee + Spouse $1,161.21 $567.08 $594.13
Employee + Child(ren) $1,068.10 $567.08 $501.02
Family $1,667.88 $567.08 $1,100.80
MEDICAL: Kaiser Permanente
Employee Only $404.04 $404.04 $0.00
Employee + Spouse $808.08 $404.04 $404.04
Employee + Child(ren) $727.28 $404.04 $323.24
Family $1,212.13 $404.04 $808.09
Dental

DENTAL: Aetna
Employee Only $51.87 $51.87 $0.00
Employee + Spouse $104.84 $51.87 $52.97
Employee + Child(ren) $132.92 $51.87 $81.05
Family $191.21 $51.87 $139.34

Vision

VISION: Aetna
Employee Only $9.40 $0.00 $9.40
Employee + 1 $17.86 $0.00 $17.86
Employee + 2 or more $26.23 $0.00 $26.23

Other Benefits

The following benefits are provided to you at no charge and are paid by FotoKem:
 Health Advocate
 Basic Life/AD&D
 Short Term Disability
 Long Term Disability
 Employee Assistance Program

The following benefits are available to you at discounted group rates. Should you elect these benefits, you will
pay 100% of the cost:
 Voluntary Life/Ad&D
 Voluntary Benefits
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