Page 29 - Lyon Benefits Guide 01-18 CA - FINAL

EMPLOYEE CONTRIBUTIONS

This chart compares the bi-weekly 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. This means that contributions are taken from your earnings before taxes, resulting in lower taxes and increased take home
pay. For your convenience, your age-banded Voluntary Life/AD&D and Voluntary Short Term Disability rates have been precalculated
for you in bswift.

EMPLOYEE COST EMPLOYEE COST
PER PAYCHECK PER PAYCHECK
MEDICAL EMPLOYEE ASSISTANCE PROGRAM

SELECT NETWORK HMO EMPLOYEE ASSISTANCE
Employee Only $0.00 PROGRAM
Employee + 1 Dependent $229.00 Employee + Household No Charge
Employee + Family $330.00 LIFE AND AD&D
FULL NETWORK HMO BASIC LIFE AND AD&D
Employee Only $20.00 Employee Only No Charge
Employee + 1 Dependent $255.00
Employee + Family $367.00 Employee VOLUNTARY

PPO Spouse LIFE AND AD&D
100% of Cost
Employee Only $80.00 Child(ren)
Employee + 1 Dependent $360.00 See bswift for age-banded rates
Employee + Family $515.00 DISABILITY

HDHP WITH HSA VOLUNTARY SHORT
Employee Only $53.00 TERM DISABILITY
Employee + 1 Dependent $267.00 100% of Cost
Employee + Family $385.00 Employee Only See bswift for age-banded rates
DENTAL LONG TERM DISABILITY
Employee Only No Charge
DHMO
Employee Only $1.52 SUPPLEMENTAL BENEFITS
Employee + 1 Dependent $6.84 ACCIDENT
Employee + Family $12.55 Employee Only $7.22
PPO Employee + Spouse $11.20
Employee Only $19.59 Employee + Child(ren) $13.05
Employee + 1 Dependent $46.43 Employee + Family $17.39
Employee + Family $79.98 HOSPITAL INDEMNITY
VISION Employee Only $6.20
Employee + Spouse
PPO Employee + Child(ren) $10.25
$10.25
Employee Only $0.74 Employee + Famil
Employee + 1 Dependent $1.91 $14.90
Employee + Family $4.03 Employee Only LEGAL SERVICES
CASH IN LIEU OF BENEFITS $11.08
Waive Medial, Dental, and $50 Credit Home & Auto and Pet Insurance: Rates vary based on the level of
Vision benefits coverage you choose. Contact the carriers to receive a quote.

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