Per-Pay-Period Plan Costs

Anthem PPO $750

Employee Only: $63.74

Employee and Spouse/DP: $215.93

Employee and Child(ren): $189.98

Employee and Family: $388.05

Anthem PPO $3,000

Employee Only: $59.36

Employee and Spouse/DP: $132.37

Employee and Child(ren): $126.43

Employee and Family: $185.59

Delta Dental PPO

Employee Only: $2.33

Employee and Spouse/DP: $12.91

Employee and Child(ren): $15.89

Employee and Family: $21.79

VSP Vision

Employee Only: $4.39

Employee and Spouse/DP: $7.02

Employee and Child(ren): $7.16

Employee and Family: $11.55

Domestic Partner Coverage

Please note that unless your domestic partner is your tax dependent as defined by the IRS, contributions for domestic partner coverage must be made after-tax. Similarly, the company contribution toward coverage for your domestic partner and his/her dependents will be reported as taxable income on your W-2. Contact your tax advisor for more details on how this tax treatment applies to you. Notify Napoleon if your domestic partner is your tax dependent.