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
* Family coverage includes Team Member, Spouse/Registered Domestic Partner, and Child/Children.

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
* Family coverage includes Team Member, Spouse/Registered Domestic Partner, and Child/Children.