Your Benefits Costs Providing our employees with quality employee benefits at an affordable cost is important to us, so we subsidize a substantial portion of the costs of your benefits. Your portion of the costs are shown below. ono cens Emloee | cesspoweor | éEchid | eEechiien | eE+Famiy sone eA $126.50 $235.40 $192.50 $192.50 $338.80 brew $121.53 $267.37 $218.75 $218.75 $376.74 MetLife - PPO $9.38 $19.23 $22.44 $22.44 $33.82 \sp - PPO $1.0 $2.00 $2.00 $3.00 $3.00 Life, STD & LTD Plans 100% company paid *Domestic partner income: Employers offering domestic partner benefits must abide by federal tax regulations, In most instances, this will require employees to receive imputed income equal to the fair market value of the coverage, reduced by any post tax premiums the employee pays for this coverage. Contact a qualified accountant for tax details andor see the following resource for ‘more information: www its.gov/irb/2004-49_IRB/ar10.html Monthly Employer HSA Contributions If you enroll in the HSA medical plan option, we will contribute the following amounts to your HSA account Employee + ; Employee | Employee + Employee Only |“ Trousey __[Emblovee + Child] Chidren ei $125.00 $250.00 $250.00 $250.00 $250.00