My Benefits
Your Medical Benefits
Eligibility: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
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: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
EligibilityContributions
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
EligibilityContribution 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
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
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
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
Contributions
Helpful Resources
mylegalshield.com
