Premiums (paycheck deductions

2021 Premiums (paycheck deductions) Health Plans: HRA, HSA and Bind

Health Tier 1* HRA Plan

Coverage level Bi-weekly cost with discount** Associate Only $59.18 Associate Plus Spouse/Partner $138.84 Associate Plus One Child $109.13 Associate Plus 2 Children $145.50 Associate Plus 3 Children $174.60 Associate Plus 4 Children $203.71 Associate Plus Spouse/Partner & Child $203.31 Associate Plus Spouse/Partner & 2 Children $243.17 Associate Plus Spouse/Partner & 3 Children $275.06 Associate Plus Spouse/Partner & 4+ Children $306.95

Health Tier 2* HRA Plan

Coverage level Bi-weekly cost with discount** Associate Only $103.81 Associate Plus Spouse/Partner $240.57 Associate Plus One Child $176.08 Associate Plus 2 Children $242.23 Associate Plus 3 Children $290.68 Associate Plus 4 Children $339.13 Associate Plus Spouse/Partner & Child $329.06 Associate Plus Spouse/Partner & 2 Children $393.55 Associate Plus Spouse/Partner & 3 Children $445.17 Associate Plus Spouse/Partner & 4 + Children $496.76

Health Tier 3* HRA Plan

Coverage level Bi-weekly cost with discount** Associate Only $44.51 Associate Plus Spouse/Partner $118.33 Associate Plus One Child $86.65 Associate Plus 2 Children $115.54 Associate Plus 3 Children $138.64 Associate Plus 4 Children $161.76 Associate Plus Spouse/Partner & Child $180.95 Associate Plus Spouse/Partner & 2 Children $216.40 Associate Plus Spouse/Partner & 3 Children $244.78 Associate Plus Spouse/Partner & 4 + Children $273.14

HSA Plan Bi-weekly cost with discount** $48.53 $117.02 $93.16 $124.21 $149.06 $173.90 $176.17 $210.70 $238.33 $265.96

HSA Plan Bi-weekly cost with discount** $93.17 $218.75 $160.11 $220.94 $265.13 $309.32 $301.91 $361.08 $408.44 $455.77

HSA Plan Bi-weekly cost with discount** $33.87 $96.51 $70.69 $94.25 $113.10 $131.95 $153.80 $183.93 $208.05 $232.15

Bind Bi-weekly cost with discount** $41.43 $102.46 $82.51 $110.01 $132.01 $154.01 $158.06 $189.04 $213.83 $238.61

Bind Bi-weekly cost with discount** $86.07 $204.19 $149.46 $206.74 $248.08 $289.43 $283.80 $339.42 $383.94 $428.43

Bind Bi-weekly cost with discount** $26.76 $81.95 $60.03 $80.04 $96.05 $112.06 $135.69 $162.26 $183.55 $204.81

2021 Premiums (paycheck deductions) Dental and Vision

Dental: Tier 1 Options

Dental Basic

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Plus

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Premier

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental: Tier 3 Options 30+ hours work/week Dental Basic

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Plus

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Premier

Associate Only Associate Plus One Associate Plus Children Associate Plus Family Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Bi–Weekly

Cost

$8.86 $19.83 $25.32 $36.30

$11.45 $25.04 $27.74 $41.33

$14.25 $30.61 $43.54 $59.90

Bi–Weekly

Cost

$8.86 $19.83 $25.32 $36.30

$11.45 $25.04 $27.74 $41.33

$14.25 $30.61 $43.54

Vision:

Tier 1, Tier 2, Tier 3 Options

$59.90

Bi–Weekly Cost

$4.32 $6.18 $6.59 $11.48

Dental: Tier 2 Options Dental Basic

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Plus

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Premier

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental: Tier 3 Options 20-29 hours work/week Dental Basic

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Plus

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Dental Premier

Associate Only Associate Plus One Associate Plus Children Associate Plus Family

Bi–Weekly

Cost

$10.26 $22.01 $27.90 $39.66

$12.85 $27.23 $30.32 $44.69

$15.65 $32.80 $46.12 $63.26

Bi–Weekly

Cost

$10.26 $22.01 $27.90 $39.66

$12.85 $27.23 $30.32 $44.69

$15.65 $32.80 $46.12 $63.26

*Tier 1: Salary >$40,000 and 30+ hours work/week *Tier 2: Salary >$40,000 and 20-29 hours work/week *Tier 3: Salary <$40,000 and 20+ hours work/week

**Discount assumes full attainment of HLwR points and tobacco-free status

2021 Premiums (paycheck deductions) Legal, Long Term Disability, Life Insurance

Legal

Standard: Associate Plus Family Plus Parents: Associate/Family/Parents

Bi-Weekly Associate Cost

$7.62 $10.38

Annual Plan Cost

$198.12 $269.88

Long Term Disability

LTD-50%

LTD-60%

Bi-Weekly Associate Cost

Example: Insured Salary $80,000/100=800*.123=Annual $98.40 or Bi-Weekly $3.78 Example: Insured Salary $80,000/100=800*.237=Annual $189.60 or Bi-Weekly $7.29

Associate and Spouse/Partner Life Insurance Age as of 1/01/2021:

Under 30 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

Bi-Weekly Associate Cost

Associate: Per $1,000

$0.023 $0.032 $0.035 $0.036 $0.052 $0.073 $0.131 $0.195 $0.368 $0.591

Annual Plan Cost

Insured Salary divided by $100 multiplied by $0.123

Insured Salary divided by $100 multiplied by $0.237

Bi-Weekly Associate Cost

Spouse/Partner: Per $1,000 $0.024 $0.034 $0.036 $0.040 $0.054 $0.078 $0.139 $0.210 $0.395 $0.636

$5,000-$25,000

Child Life

Per $1,000: $0.068

2021 Premiums (paycheck deductions) Critical Illness, Personal Accident, Hospital Indemnity

Personal Accident

Associate Only Associate Plus Spouse/Partner Associate Plus Child(ren) Associate Plus Family

Bi-Weekly Associate Cost

$2.61 $4.16 $4.97 $6.47

Annual Plan Cost

$67.92 $108.12 $129.24 $168.24

Critical Illness*

Age as of 01/01/2021:

18-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

$10,000 Level

Bi-Weekly Associate Cost $2.77 $3.78 $5.26 $8.12 $11.63 $16.29 $22.06 $31.15 $42.88 $58.52

Annual Associate Cost

$72.00 $98.40 $136.80 $211.20 $302.40 $423.60 $573.60 $810.00 $1,114.80 $1,521.60

$20,000 Level

Bi-Weekly Associate Cost $5.54 $7.57 $10.52 $16.25 $23.26 $32.58 $44.12 $62.31 $85.75 $117.05

Annual Associate Cost $144.00 $196.80 $273.60 $422.40 $604.80 $847.20 $1,147.20 $1,620.00 $2,229.60 $3,043.20

*Rates are for associate only. Can also cover spouse/partner and children for additional premium.

Hospital Indemnity

Associate Only Associate Plus Spouse/Partner Associate Plus Child(ren) Associate Plus Family

Bi-Weekly Associate Cost

$5.62 $13.76 $9.47 $17.61

Annual Plan Cost

$146.04 $357.72 $246.24 $457.92