Page 19 - Premier EE Guide 01-20 - CA- Updated 01.03.2020

EMPLOYEE CONTRIBUTIONS

This chart compares the per paycheck 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 and AD&D and premiums have been pre-
calculated for you in Paycom.

Medical Blue Shield Blue Shield Blue Shield
Trio HMO Access+ HMO HDHP PPO
Employee Only $41.46 $83.13 $109.14
Employee + Spouse $136.80 $217.19 $240.12
Employee + Child(ren) $111.92 $177.70 $196.46
Employee + Family $ 192.76 $306.03 $338.35

Dental United Concordia United Concordia
DHMO DPPO

Employee Only $3.43 $21.17
Employee + 1 Dependent $10.17 $46.11
Employee + Family $18.16 $69.60
Vision EyeMed Vision
PPO
Employee Only $3.03
Employee + 1 Dependent $5.75
Employee + Family $8.44

The following benefits are provided to you at no charge and are paid by PACU
• Basic Life and AD&D
• Employee Assistance Program

The following benefit is paid by PACU, but you also have the option to pay for this benefit yourself with post-tax
payroll contributions to receive a tax-free benefit at the time of disability:
• Long Term Disability

PACU Pays You Pay
Disability Benefits are TAXED Disability Benefits are NOT TAXED

Employee Annual Salary $70,000 Employee Annual Salary $70,000

Annual LTD Benefit $35,000 OR Annual LTD Benefit $35,000
(50% of Salary Max $6,000/Month) (50% of Salary Max $6,000/Month)
Annual Taxes (assumed at 30%) $10,500 Annual Taxes (assumed at 30%) $0

Final Annual LTD Claim Payment $24,500 Final Annual LTD Claim Payment $35,000

19