California
| Medical Coverage (Pre-Tax; Monthly) |
Blue Shield PPO $aver/ HSA Plan | Blue Shield PPO Super $aver/ HSA Plan | Blue Shield HMO Plan | Blue Shield Trio HMO Plan | Kaiser HMO | Kaiser Deductible HMO |
|---|---|---|---|---|---|---|
| Team Member Only | $200.00 | $100.00 | $225.00 | $100.00 | $210.00 | $140.00 |
| Team Member + Spouse/Registered Domestic Partner | $445.00 | $310.00 | $495.00 | $310.00 | $485.00 | $375.00 |
| Team Member + Child(ren) | $400.00 | $275.00 | $445.00 | $275.00 | $435.00 | $330.00 |
| Family* | $910.00 | $620.00 | $845.00 | $620.00 | $830.00 | $695.00 |
| Dental Coverage (Pre-Tax; Monthly) | DeltaCare USA DHMO | Delta Dental PPO |
|---|---|---|
| Team Member Only | $0.00 | $15.00 |
| Team Member + Spouse/Registered Domestic Partner | $17.00 | $60.00 |
| Team Member + Child(ren) | $15.00 | $50.00 |
| Family* | $32.00 | $105.00 |
| Vision Coverage (Pre-Tax; Monthly) | VSP Base | VSP Premier |
|---|---|---|
| Team Member Only | $6.00 | $9.00 |
| Team Member + Spouse/Registered Domestic Partner | $15.00 | $22.00 |
| Team Member + Child(ren) | $13.00 | $20.00 |
| Family* | $21.00 | $30.00 |
All States Other Than California
| Medical Coverage (Pre-Tax; Monthly) |
Blue Shield PPO $aver/ HSA Plan | Blue Shield PPO Super $aver/ HSA Plan | Blue Shield EPO Plan |
|---|---|---|---|
| Team Member Only | $200.00 | $100.00 | $230.00 |
| Team Member + Spouse/Registered Domestic Partner | $445.00 | $310.00 | $510.00 |
| Team Member + Child(ren) | $400.00 | $275.00 | $460.00 |
| Family* | $910.00 | $620.00 | $875.00 |
| Dental Coverage (Pre-Tax; Monthly) | DeltaCare USA DHMO | Delta Dental PPO |
|---|---|---|
| Team Member Only | $0.00 | $15.00 |
| Team Member + Spouse/Registered Domestic Partner | $17.00 | $60.00 |
| Team Member + Child(ren) | $15.00 | $50.00 |
| Family* | $32.00 | $105.00 |
| Vision Coverage (Pre-Tax; Monthly) | VSP Base | VSP Premier |
|---|---|---|
| Team Member Only | $6.00 | $9.00 |
| Team Member + Spouse/Registered Domestic Partner | $15.00 | $22.00 |
| Team Member + Child(ren) | $13.00 | $20.00 |
| Family* | $21.00 | $30.00 |