Page 7 - Tender Greens EE Guide 01-20 Non-CA.pub

Contributions

Team Member Portion
Plan (Per Pay Period)
Medical Options

PPO HDHP
Team Member Only $45
Team Member + Spouse $134
Team Member + Child(ren) $109
Team Member + Family $194
PPO
Team Member Only $130
Team Member + Spouse $336
Team Member + Child(ren) $245
Team Member + Family $467

Dental Option
Team Member Only $6
Team Member + Spouse $16
Team Member + Child(ren) $19
Team Member + Family $27

Vision Option
Team Member Only $1
Team Member + Spouse $3
Team Member + Child(ren) $3
Team Member + Family $5

The following benefits are provided to you at no charge and The following benefits are available to you at discounted group
are paid by Tender Greens: rates. Should you elect these benefits, you will pay 100% of the
 Basic Life/AD&D cost:
 Employee Assistance Program  Voluntary Life/AD&D
 Travel Assistance  Voluntary Short Term Disability
 Will Preparation Assistance  Voluntary Long Term Disability

For your convenience, your age-banded Voluntary Life/AD&D, Short

Term Disability and Long Term Disability premiums have been

pre-calculated for you in UltiPro.

Team Member Benefits
Team Member Benefits 7 7