Your Medical Benefits

Medical Contribution Schedule

 PPO
Cost Per Month
HSA *
Cost Per Month
HMO
Cost Per Month
Employee$175.00$30.00$30.00
Employee + spouse$475.00$350.00$350.00
Employee + children$424.00$300.00$300.00
Employee + family$625.00$500.00$500.00

Employer one time contribution into your HSA: EE: $500; EE+SP: $750; EE+CH: $750; FAM: $1050
(If switch back to the PPO within 3yrs, this will be owed back to GW)

*Insurance deductions will only be taken out 24 paychecks per year

Helpful Resources

Carrier Service Contact
BlueCross BlueShield of IL
PPO Phone: 1-800-541-2768
HSA Phone: 1-800-414-7147
HMO Phone: 1-800-541-2767
www.bcbsil.com

HMO Group # : B01155
Blue Choice Options Group # : 132115
H.S.A Group # : PF2362

Your Dental Benefits

Eligibility

All full-time employees who work at least thirty (30) hours per week are eligible for coverage the first of the month following date of employment.

Dental Contribution Schedule

 Cost Per Month
Employee$0.00
Employee + spouse$40.97
Employee + children$43.20
Employee + family$84.16
Helpful Resources

Carrier Service Contact
BlueCross BlueShield of IL
Phone: 1-800-367-6401
www.bcbsil.com

Group # : 215293

Your Vision Benefits

Eligibility:

All full-time employees who work at least thirty (30) hours per week are eligible for coverage the first of the month following date of employment.

Vision Contribution Schedule

 Per Month
Employee$6.91
Employee + spouse$11.05
Employee + children$11.28
Employee + family$18.19
Helpful Resources

Carrier Service Contact
VSP
Phone: (800) 877-7195
www.vsp.com

Group # : 30076906

Your 401k

Contributions

Please contact your HR department for more information regarding your contributions.

Helpful Resources

Ascensus
Phone: (888) 800-5359
www.myaccount.ascensus.com/ml

Plan # : 231649

Your Group Life Benefits

Eligibility

All full-time employees who work at least thirty (30) hours per week are eligible for coverage the first of the month following date of employment.

Contribution Schedule

Group Life premium is paid by the company.

Helpful Resources

Carrier Service Contact
Dearborn National
Phone: 1-800-348-0487
www.dearbornnational.com

Group # : F020388

Your Voluntary Life Benefits

Eligibility

All full-time employees who work at least thirty (30) hours per week are eligible for coverage the first of the month following date of employment.

Forms and Plan Documents
Contribution Schedule

Click Here to view the Voluntary Life Contribution Schedule.

Helpful Resources

Carrier Service Contact
Dearborn National
Phone: (800) 348-4512
www.dearbornnational.com
Email: contactus@dearbornnational.com

Group # : F020388

Your Short Term Disability Benefits

Eligibility

All full-time employees who work at least thirty (30) hours per week are eligible for coverage the first of the month following date of employment.

Contribution Schedule

The Short Term Disability premium is paid by the company.

Helpful Resources

Carrier Service Contact
Dearborn National
Phone: 1-800-348-0487
www.dearbornnational.com

Group # : F020388

Your Long Term Disability Benefits

Eligibility

All full-time employees who work at least thirty (30) hours per week are eligible for coverage the first of the month following date of employment.

Contribution Schedule

The Long Term Disability premium is paid by the company.

Helpful Resources

Carrier Service Contact
Dearborn National
Phone: 1-800-348-0487
www.dearbornnational.com

Group # : F020388

Your LegalShield Benefits