Page 13 - PLM Benefit Guide 4-2018 - Non-CA Final

Employee Contributions

Health Benefit Costs

This chart compares the per paycheck costs 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 medical, voluntary life and AD&D, accident,
critical illness, and hospital indemnity premiums have been pre-calculated for you in EaseCentral.

Medical Sample Age
Employee Only / Employee + Family*
Cost Per Paycheck

MEDICAL OPTIONS Age 35 Age 40 Age 45 Age 50 Age 55
Blue Shield Silver Full PPO 2000 $37.20 / $246.64 $38.90 / $252.61 $43.96 / $270.29 $54.37 / $306.73 $67.89 / $354.04
Blue Shield Platinum Full PPO $107.31 / $474.64 $112.22 / $487.02 $126.80 / $523.76 $156.84 / $599.45 $195.82 / $697.69

DENTAL OPTION ANTHEM
DPPO

Employee Only $14.17
Employee + Spouse $30.97
Employee + Child(ren) $31.37
Employee + Family $52.18

VISION OPTION ANTHEM
PPO

Employee Only $0.66
Employee + Spouse $2.32
Employee + Child(ren) $2.06
Employee + Family $3.81

BASIC LIFE AND AD&D / LONG MUTUAL OF OMAHA
TERM DISABILITY
Employee Only Paid by PLM Operations

EMPLOYEE ASSISTANCE MUTUAL OF OMAHA
PROGRAM

Employee + Family Paid by PLM Operations
VOLUNTARY LIFE AND AD&D MUTUAL OF OMAHA

Employee + Family For your convenience, your voluntary premiums have been
pre-calculated for you in Ease Central
ACCIDENT / CRITICAL ILLNESS / UNUM
HOSPITAL INDEMNITY
Employee + Family For your convenience, your voluntary premiums have been
pre-calculated for you in Ease Central

*Family assumes spouse at same employee age and 2 children under age 14

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