Page 18 - Hitachi Benefit Guide 1.31.2019

Team Member Contributions

This chart compares the per paycheck contributions for our Health Advocate, Life Assistance Program, Basic Life and AD&D,
Team Member benefit plans. Your cost for coverage will vary Business Travel Accident, Short Term Disability and Travel
depending on the option and level of coverage you choose. Assistance Program are provided to you at no charge and are
paid by Hitachi Solutions. For states that require the company
For your convenience, your age-banded Voluntary Life and to have a statutory disability policy (CA, HI, NY & NJ) you and
AD&D premiums have been pre-calculated for you on our the Company may share in the cost via payroll deduction as
online enrollment system. Team Member contributions for permitted by law.
Medical, Dental, and Vision are deducted from your paycheck
Voluntary Life and AD&D, Voluntary Long Term Disability and
with pre-tax dollars. This means that contributions are taken Pet Insurance benefits are available to you at discount group
from your earnings before taxes, resulting in lower taxes and rates through Hitachi Solutions. Should you elect these
increased take home pay.
benefits, you will pay 100% of the cost.
Medical Plans Semi-Monthly Cost Cigna Long Term Disability
Aetna HMO (CA Only) Semi-Monthly Rate / $100 of Covered Benefit
Option 1: 60% to $5,000/month $0.225
Employee Only $25.00
Option 2: 66 2/3% to $12,500/month $0.280
Employee + Spouse $69.00
Employee + Child(ren) $63.00 Cigna Voluntary Life and AD&D
Employee + Family $125.00 Semi-Monthly Rate / $1,000 of Benefit for EE or SP*
Kaiser HMO (CA Only) Under 25 $0.025 45-49 $0.112
Employee Only $24.00 25-29 $0.030 50-54 $0.193
Employee + Spouse $66.00 30-34 $0.040 55-59 $0.327
Employee + Child(ren) $60.00
35-39 $0.045 60-64 $0.500
Employee + Family $120.00
40-44 $0.066 64+ $0.782
Aetna High Deductible HSA
Cigna Child(ren) Life Only
Employee Only $25.00
Employee + Spouse $69.00 Semi-Monthly Rate per Child(ren) $0.90 for $10,000 benefit
Employee + Child(ren) $63.00 *Rates based on employee’s age at initial entry and thereafter age as of January 1.
Employee + Family $125.00 Spouse’s age is based on employee’s age.
Rounding: Life and Disability plans are pre-calculated for your on the Sterling
Aetna Silver PPO
Online System. Manual calculations may have rounding differences.
Employee Only $47.00
Employee + Spouse $139.00 LifeLock Identity Theft Plans Semi-Monthly Cost
Employee + Child(ren) $122.00 Benefit Elite Ultimate Plus
Employee + Family $215.00 Employee Only $2.99 $10.99
Aetna Gold PPO Employee + 1 or More Dependents $6.99 $22.99
Employee Only $70.00
ID Cards
Employee + Spouse $190.00
The following cards are mailed or available online only. If a card is
Employee + Child(ren) $180.00 mailed, it generally takes 7-10 business days from the date the
Employee + Family $300.00 insurance carrier receives enrollment. Often times, a mailed ID card will
Aetna Platinum PPO be in a white non-disclosed envelope. Providers can generally verify
eligibility with the policy and your Social Security Number.
Employee Only $200.00 • Aetna Medical & EyeMed Vision: ID card will be mailed to your home.
Employee + Spouse $445.00
• Dental: Online only. You must register as a member online at
Employee + Child(ren) $420.00 www.deltadentalins.com to download an ID card. User type:
Employee + Family $665.00 Enrollee/Adult Dependent and Social Security Number (SSN) and date
Dental Plans Semi-Monthly Cost of birth will be required to set up an account.
• Igoe Flexible Spending and Health Savings Accounts: If enrolled, you
Employee Only $7.00
will receive your debit card in the mail. If you don’t receive a debit
Employee + One Dependent $16.00 card, go to www.goigoe.com.
Employee + Family $29.00
Vision Plans Semi-Monthly Cost Mobile Apps
The insurance carriers also have mobile apps so you can have your ID
Employee Only $1.00
cards on the go. If you would like replacement cards and do not wish to
Employee + One Dependent $2.00 do so online, please contact member services on page 19. Note: Delta
Employee + Family $4.00 Dental does not mail ID cards. You must register online and print a card.

18 Hitachi Solutions America Employee Benefits Guide | 2019