Monthly Benefits Rates For Benefits Plans Effective October 1, 2013 thru September 30, 2014
Health Plans Plans Medical – Choice Plus Plan Medical – High Deductible Plan Dental Vision
Associate Only $126.00 $75.00 $30.41 $6.50
Associate and Spouse $335.00 $232.00 $55.93 $12.40
Associate and Child(ren) $283.00 $189.00 $59.19 $13.00
Associate and Family $463.00 $309.00 $87.42 $20.00
Health Savings Account Annual Contributions (Contributed by Mattress Firm for Associates Participating in the Medical – High Deductible Plan) Associate Only
Associate and Spouse
Up to $240
Up to $360
Associate and Child(ren) Up to $360
Associate and Family Up to $480
Voluntary Term Life *Associate’s Coverage $10,000 - $500,000
*Spousal Coverage $10,000 - $250,000
Cost Per $10,000 of Coverage <25 0.53 25-29 0.64 30-34 0.85 35-39 0.95 40-44 1.06 45-49 1.59 50-54 2.43 55-59 4.55 60-64 6.98 65-69 13.43 *EOI required for coverage in excess of $200,000 Age
Child(ren) Coverage
Based on Cost Per Associate’s $10,000 of Age Coverage <25 0.53 25-29 0.64 30-34 0.85 35-39 0.95 40-44 1.06 45-49 1.59 50-54 2.43 55-59 4.55 60-64 6.98 65-69 13.43 *EOI required for coverage in excess of $100,000
Coverage $2,000 $4,000 $6,000 $8,000 $10,000
Cost Per $2,000 of Coverage 0.240 0.480 0.720 0.960 1.200
Voluntary Accidental Death and Dismemberment (AD&D) Associate’s AD&D Coverage $10,000 to $500,000
Cost Per $10,000 of Coverage 0.30
Spousal AD&D Coverage $10,000 to $250,000
Cost Per $10,000 of Coverage
Child(ren) AD&D Coverage
Cost Per $2,000 of Coverage
0.30
$2,000 $4,000 $6,000 $8,000 $10,000
0.240 0.480 0.720 0.960 1.200
Information contained in this document are summarizations and not intended to replace the full details regarding eligibility, covered expenses, exclusions, limitations, definitions and other provisions of each plan contained in legal documents, handbooks and group contracts. Legal documents shall govern any differences.