BENEFITS GUIDE

January 1 – December 31, 2020

03 | INTRODUCTION
05 | ANKURABENEFITS.COM
06 | MEDICAL INSURANCE
08 | HEALTH SAVINGS ACCOUNT
09 | FLEXIBLE SPENDING ACCOUNT
11 | DENTAL INSURANCE
12 | VISION INSURANCE
13 | DISABILITY PLANS
14 | LIFE INSURANCE
15 | ADDITIONAL BENEFITS
16 | 401(K) RETIREMENT PLAN
17 | COST OF COVERAGE
20 | CONTACT INFORMATION

CONFIDENTIAL
INTRODUCTION
We recognize you work hard on behalf of the firm, and we understand the importance of being there for your family
and friends. One of the important ways we support your pursuit of a healthy life as an Ankura employee is by providing
a comprehensive benefits platform that allows you to elect the plan coverage that meets your needs. Supporting you
and your dependents’ physical and mental well-being through Ankura benefits is important to us, and we are here to
help you make the best decision for yourself and your family.
Eligibility and required contributions for these benefits and programs depend on your employee classification, your
annual base pay, and whether you elect to extend coverage to your dependents. Full-time employees are eligible for
Ankura’s benefits programs. You are considered full-time if you are scheduled to work 30 or more hours per week.
Full-time employees are eligible for coverage on the first day of employment.

Changing Benefit Elections

Once you make your elections, they will remain in effect from January 1, 2020 through December 31, 2020, unless
you have a Qualifying Life Event, also known as a designated family status change event. Examples of such life
events include:

Qualifying Life Events

Change in marital status (marriage, death of spouse, divorce or legal separation)

Change in number of dependents (birth, death, adoption, eligibility status, child support order)

Change in employment status for you or your spouse (new employment, termination, leave of absence,
full-time to part-time or part-time to full-time)

Special enrollment rights under HIPAA (Health Insurance Portability and Accountability Act of 1996)

Medicare coverage

3 CONFIDENTIAL
 NEW NEW

NEW
MEDICAL
and
HSA
FLEXIBLE
SPENDING
TRANSIT/ DENTAL
COMMUTER
ACCOUNTS

YOUR
EMPLOYEE
ANKURA
ASSISTANCE VISION
PROGRAM BENEFITS
ECOSYSTEM

VOLUNTARY
BASIC LIFE/
LIFE/
AD&D
AD&D
SHORT & LONG
TERM
DISABILITY

4 CONFIDENTIAL
 All your benefits in
the palm of your hand

ankurabenefits.com is your one-stop How to access to AnkuraBenefits.com:

• First Time Access: Select “Register” to walk through
shop for everything related to your health
the registration process
and welfare benefits, including but not • Benefits Dashboard: Contains benefit
limited to: announcements and links to enroll/change benefits,
as well as a link to 401K participant portal
• Making elections during open enrollment
• Making changes if you experience a qualifying event
Workday feeds your personal information to
during the year
AnkuraBenefits.com
• Accessing plan details, documents and certificates
• Any changes to your personal information must be
• Live chat and phone numbers for assistance done in Workday to ensure the correct information is
• Links to all provider websites and resources housed in AnkuraBenefits.com

• All of your benefits information on the

MyChoiceSM Mobile App!

Additional questions or need help?

Contact Ankura Benefits: 833-261-5443
Available 8 am – 8 pm EST

5 CONFIDENTIAL
MEDICAL

Information below reflects In-Network services only

PPO Plan Low Plan High Plan

Benefits/Services In-Network In-Network In-Network

Annual Deductible Individual/Family $600 / $1,200 $1,500 / $3,000 $2,800 / $4,000

Annual Out-of-pocket Max. Individual/Family $3,000 / $6,000 $3,500 / $7,000 $4,000 / $8,000

Coinsurance (what the plan pays) 80% after deductible 80% after deductible 80% after deductible

Office Visit PCP / Specialist $25 copay / $50 copay 80% after deductible 80% after deductible

Preventive Care /Annual Physicals/Screenings Covered at 100% Covered at 100% Covered at 100%

Lab, X-Ray, Major Diagnostics and Imaging 80% after deductible 80% after deductible 80% after deductible

Emergency Room Services 80% after deductible 80% after deductible 80% after deductible

Urgent Care Services 80% after deductible 80% after deductible 80% after deductible

Hospital – Inpatient 80% after deductible 80% after deductible 80% after deductible

Hospital - Outpatient 80% after deductible 80% after deductible 80% after deductible

Mental Health Inpatient 80% after deductible 80% after deductible 80% after deductible

Mental Health Outpatient $50 copay 80% after deductible 80% after deductible

Prescription Drug Coverage PPO Plan Low Plan High Plan*

$10 copay after
Generic $10 copay $10 copay
deductible

50% coinsurance 50% coinsurance 40% coinsurance

Non-Preferred Generic
Min $25 / Max $75 Min $25 / Max $100 to a max of $100

30% coinsurance 30% coinsurance 30% coinsurance

Preferred Brand
Min $25 / Max $75 Min $25 / Max $75 to a max $75

50% coinsurance 50% coinsurance 40% coinsurance

Non-Preferred Brand
Min $25 / Max $100 Min $25 / Max $100 to a max of $100

50% coinsurance 50% coinsurance 50% coinsurance

Specialty Drugs
to a max of $150 to a max of $150 to a max of $150

Mail Order 2.2 to 2.5 x Retail 2.2 to 2.5 x Retail 1 x Retail

*The medical deductible must be met before the calculations will apply
Ankura will contribute to High Plan participants Health Savings Accounts (HSA).
2020 Ankura contributions will be $500 individual/$1,000 families to be deposited per paycheck

6 CONFIDENTIAL
ADDITIONAL MEMBER TOOLS AND RESOURCES:
Find a Doctor
DocFind is Aetna’s online provider directory where you
can search for in-network doctors, hospitals, facilities, or
pharmacies in the Open Access Managed Choice Network:
• Log onto www.aetna.com
• Click on ‘Find a Doctor’ at the top of the page
• Click on ‘Find Providers’ under ‘Already a member?’ (In
order to create an account, select ‘Plan
• from an employer’ under ‘Not a member yet?’ and
follow the prompts.)
• Filter your search by the type of doctor, name of a
hospital or facility and enter your zip code search under ‘Health Programs’
• Select the Managed Choice® POS (Open Access)
network from the drop-down menu under ‘Aetna
• Open Access® Plans’
Beginning Right Maternity
Beginning Right Maternity Program provides special
attention for a healthy pregnancy and baby, including:
• Help to quit smoking
• Information for a healthier pregnancy
• Nurse Case Managers to help manage high-risk
conditions
• Online resources
• To sign up:
• Call Aetna at 1-800-CRADLE-1 (1-800-272-3531),
weekdays from 8 am – 7pm ET
7 CONFIDENTIAL
Speak to a Nurse
For any health-related questions, call Aetna’s 24-hour
Informed Nurse Line:
• Learn about medical procedures and treatment
options
• Improve how you talk to your doctor and other health
care providers
• Find out how to describe your symptoms better
• Ask the right questions
• Call 1-800-556-1555
• Log in to you member website at www.aetna.com and
Emergencies and Travel
Emergency services are available worldwide. Emergency
care while traveling outside of the country, requires you
to pay for services and then submit claims to Aetna for
reimbursement. You will need to obtain an itemized
receipt and file a claim with Aetna. The claim will be
processed at the foreign currency exchange rate.
Additional member tools and resources
can be found on ankurabenefits.com
HEALTH SAVINGS ACCOUNT / HSA
What is a Health Savings Account (HSA)? Tax-advantages:
An HSA is a tax advantaged personal savings account that • Contribute pre-tax money
works in combination with a qualified high-deductible • Funds accrue tax-free
health plan (HDHP); in this case, the Ankura High Plan.
Funds are yours and remain with you regardless of where • Withdraw funds tax free (when used for eligible
you go. Funds roll over year to year. medical expenses)

Ankura will make per-paycheck contributions to your • Qualified expenses can include:
HSA to total $500 for an Individual per calendar year and o Deductibles

$1,000 for Family coverage per calendar year. o Coinsurance

o Dental/Vision Care
o Certain items not covered by your medical plan
IRS 2020 Maximum contributions:
• Individual: $3,550
• Family $7,100
Managing Your HSA
• Over 55; +$1,000 catch up
You can manage your HSA through your Aetna Navigator
portal, http://www.aetnanavigator.com or from your
To open a HSA, you: phone or tablet on the Aetna Navigator App.

• Must be enrolled in a HDHP

• Cannot be covered on another plan that is not a
HDHP
• Cannot be enrolled in Medicare
• Cannot be claimed as a dependent on anyone’s tax
return

8 CONFIDENTIAL
FLEXIBLE SPENDING ACCOUNT / FSA
Health Care FSAs
A health care flexible spending account (FSA) lets you
save on health expenses by using pre-tax dollars. You
can spend it on a wide range of needs for yourself and
your family.
The portion of your paycheck you put into your FSA is
taken out before you pay federal income taxes, Social
Security taxes, and most state taxes. It's a great way to
save money. When you enroll, you decide just how much
to contribute based on what you estimate you’ll need.
• The 2020 maximum allowable annual contribution is
$2,750
• Just remember: FSA dollars are "use-it-or-lose-it"
funds. If you do not use all your funds in the plan year,
you will forfeit them.
Limited Purpose FSAs
If you are participating in the HDHP medical plan with a
HSA and want to contribute to a FSA as well, you will be
required to use a “Limited Purpose” FSA. Limited Purpose
FSAs can only be used to pay for qualified dental and
vision expenses. You may elect $2,700. These funds are
also "use-it-or-lose-it."
9 CONFIDENTIAL
Dependent Care FSAs
A dependent care FSA is a great way to pay dependent
care expenses and lower your taxable income. You direct
part of your before-tax pay into a special account to help
pay work-related dependent care costs.
• Your maximum allowable annual contribution is
$5,000 (per household)
• A qualifying dependent is:
o A tax dependent of yours who is under age 13, or
o Anyother tax dependent of yours, such as an
elderly parent, who is physically or mentally
incapable of self-care and has the same principal
residence as you
o Aspouse who is physically or mentally incapable
of self-care and has the same principal residence
as you
• Just remember this: DCFSA dollars are "use-it-or-lose-
it" funds. Account balances cannot be carried over
from year to year.
Managing Your FSA
You can manage your HSA through your the American
Benefits Group member portal, www.amben.com,
or from your phone or tablet on the American Benefits
Group mobile app.Benefits Group mobile app.
COMMUTER BENEFIT PLAN
Through American Benefits Group, we offer a Commuter Benefit Plan. This is a tax free account for workplace commuting
expenses (including mass transit and parking expenses/excluding taxis, tolls, and fuel).
You can elect to contribute up to the limits noted below:
• Transit: $270 per month for mass transit commuting expenses
• Parking: $270 per month for parking expenses.
American Benefits Group offers a self-service online portal that includes home delivery of your transit passes. You must
make your elections by the 10th of the month for the next month. Example: January elections must be completed by
December 10th. www.mycommuterconnect.com

The transit and parking benefit will roll over from year to year while you are employed by Ankura.
If you do not use the full amount before the end of the plan year, the left over amount is carried forward to the next
plan year. However, if you terminate employment and do not submit receipts against the funds within the allotted grace
period, you will lose any funds you have not used.

10 CONFIDENTIAL
DENTAL INSURANCE
Aetna High PPO
If you are an eligible employee and elect to participate in the High PPO, most expenses are subject to an annual
deductible, with a maximum annual benefit of $5,000. This plan includes child orthodontia coverage with a lifetime
maximum of $1,200 per member.
Aetna Low PPO
If you are an eligible employee and elect to participate in the Low PPO, you are subject to an annual deductible, with a
maximum annual benefit of $1,000. Child orthodontia coverage is not included.

High Plan Low Plan

Benefits/Services In-Network In-Network

Annual Deductible (Single/Family) $50/$150 $50/$150

Maximum Annual Benefit $5,000 $1,000

Class I Preventive & Diagnostic Covered at 100% Covered at 100%

Class II Basic Restorative Care 20% after deductible 20% after deductible

Class III Major Restorative Care 50% after deductible Not Covered

Class IV Orthodontia 50% after deductible Not Covered

Orthodontia Lifetime Maximum $1,200 Not Covered

Additional benefits now offered through Aetna

• The new Aetna Dental plans match the current MetLife Dental plans (e.g. deductible amounts and annual
maximums).
• Significantly more In-Network providers based on employee utilization meaning your plan will work better for you.
• Oral Health Discounts on Z Sonic™ toothbrushes, replacement brush heads, and various oral health care kits. To
access this discount, visit the Aetna member website at aetna.com.
• Aetna Dental is the first, and currently only, carrier that covers EXPAREL as an opioid alternative for wisdom tooth
extractions
• Online transparency tool allows members to find a dentist, compare costs, schedule appointments, and compare
out-of-pocket costs for any service, like a filling or X-ray. Cost is calculated using your specific plan information.
• Aetna Dental/Medical Integration℠ program – If you are enrolled in the Ankura Medical plans and the Aetna Dental/
Medical Integration (DMI) program, you may experience lower medical claims costs, fewer hospital admissions,
better diabetes control, and improved use of cost-saving preventive care.
• Note: Aetna does not issue Dental ID cards. You may access your Dental ID information through the Aetna portal or
mobile app

11 CONFIDENTIAL
VISION INSURANCE
Aetna High PPO
Participation in the voluntary Vision Service Plan (VSP) is available to all eligible full-time employees. The most liberal
benefits are paid when you use a doctor in the VSP Choice network.
Your plan is unique in that it will allow you to access a benefit a second time within the same benefit frequency period.
In the same benefit period, you can get:
• Two pairs of prescription eyeglasses; or
• One pair of prescription eyeglasses and an allowance towards contacts; or
• Double your contact lens allowance

Benefits/Services Frequency Coverage

Exam 12 months $10 Copay

Lenses 12 months $25 Copay

Frames 24 months Covered allowance up to $150

Contact Lenses (in lieu of glasses) 12 months Covered allowance up to $150

Additional, 2nd set of glasses Frequency Coverage

Lenses 12 months $25 Copay

Frames 24 months Covered allowance up to $150

Contact Lenses (in lieu of glasses) 12 months Covered allowance up to $150

12 CONFIDENTIAL
DISABILITY INSURANCE
As an Ankura employee, you have access to comprehensive disability insurance coverage. Your ability to work and earn
an income is your most valuable asset. Disability insurance provides a portion of your income if you are unable to work
because of an illness or non-job-related injury.

STD Benefit Highlights

This policy will pay you a monthly benefit if you are unable to work due to a disabling accident or sickness. There is a
waiting period from when you become ill and when your benefits will begin. This coverage is 100% paid by Ankura.
• Provided to make up for loss of income due to temporary disability caused by personal illness or injury (subject to
review and approval by Mutual of Omaha)
• Core Benefit: 100% of regular base salary after fifth consecutive business day through 90th day of approved
disability
• On 91st day of approved disability: benefit reduces to 60% of regular base salary and continues to maximum
benefit

Coverage Type STD Benefits

Short-Term Disability (STD)
• Provided to make up for loss of income due to temporary disability
caused by personal illness or injury (subject to review and approval by
Mutual of Omaha)
• Core Benefit: 100% of regular base salary after fifth consecutive business
day through 90th day of approved disability
• On 91st day of approved disability: benefit reduces to 60% of regular base
salary and continues to maximum benefit

LTD Benefit Highlights

Long-term disability will continue to be offered as Tax-Choice. You will have the option to either pay the premium for
long-term disability yourself post-tax and, in the event of a claim, receive a tax- free benefit or have Ankura pay the cost
of the premium and if a claim is paid the benefit will be taxable.
• Income replacement begins after 180 days of sickness or disability
• Offers a 60% income replacement of base salary
• Maximum of $15,000 per month of income replacement
• Employees can either pay biweekly premium (benefits received as the result of a claim are not taxed) or have
Ankura pay (benefits received as the result of a claim are subject to applicable federal and state taxes)

Coverage Type LTD Benefits

• Income replacement begins after 180 days of sickness or disability

• Offers a 60% income replacement of base salary
• Maximum of $15,000 per month of income replacement
Long-Term Disability (LTD)
• Employees can either pay biweekly premium (benefits received as the
result of a claim are not taxed) or have Ankura pay (benefits received as
the result of a claim are subject to applicable federal and state taxes)

13 CONFIDENTIAL
LIFE INSURANCE
Your family depends on your income for a comfortable lifestyle and for the resources necessary to make their dreams—
such as a college education—a reality. Like anyone, you don’t like to think of the scenario where you’re no longer there
for your family. However, you do need to ensure their lives and dreams can continue if the worst should occur.

Basic Life and Accident Death and Dismemberment Insurance

Ankura Consulting Group, LLC’s Life AD&D Insurance plan pays benefits if you die or are seriously injured and is provided
at no cost to you.

Basic Life Benefit

1x your annual salary* up to $1,500,000
(All employees up to Director Level)

Basic Life Benefit

2x your annual salary* up to $1,500,000
(Director Level and above)

Basic Accidental Death

Matches Basic Life coverage
& Dismemberment

*The annual base salary for life insurance includes base salary plus any annual incentive bonus received in the past
12 months. For employees receiving commissions or true-ups, the annual base salary includes base salary/draw plus
commissions/true-ups paid in the prior year.

Voluntary Life and Accidental Death and Dismemberment Insurance

Employees can elect additional term life insurance for themselves through Mutual of Omaha. If you elect coverage
for yourself, you are also eligible to elect coverage for your spouse and/or children. Voluntary coverage is provided to
employees at discounted group rates. If you choose this coverage, you will pay the full cost of the benefit for yourself
and your family members.

Voluntary Employee Life Insurance
You may elect voluntary life insurance in an amount from 1 to 5 times your
annual earnings, but in no event less than $10,000 or more than $1,000,000.
Note that your voluntary life insurance amount will be rounded up to the next
higher multiple of $1,000. The guaranteed coverage amount for you is the
lesser of 5 times times your annual earnings or $500,000*.

You may select coverage for your spouse in units of $5,000 to a maximum of
Voluntary Spouse Life Insurance
$250,000. The guaranteed coverage amount for your spouse is up to $35,000*

You may select coverage for your unmarried, dependent children in units of
Voluntary Child Life Insurance
$5,000 to a maximum of $15,000. All amounts are guaranteed issue.

Voluntary Accidental Death

Matches Voluntary Life coverage elected
and Dismemberment

*Any desired coverage beyond guaranteed issue amount will require evidence of insurability (EOI).

14 CONFIDENTIAL
ADDITIONAL BENEFITS
Employee Assistance Program (EAP):
Group Number: ANAF
Sometimes a personal or professional issue can affect
your work, health, and general well-being. In these times,
you may need an experienced professional to talk with to
help you manage life’s challenges. Ankura is pleased to
offer you a comprehensive Employee Assistance Program
(EAP) from Mutual of Omaha.
The EAP is here to help support you when dealing
with issues such as emotional well-being, family and
relationships, legal and financial issues, healthy lifestyles,
or work/life transitions.
Some highlights of the EAP include:
• Unlimited telephone access to EAP professionals 24/7
• Three face-to-face sessions with a counselor (per
member per issue)
• Legal assistance and financial services
• Access to a library of educational articles and
resources through a website

Toll-free: 800-316-2796
or visit: www.mutualofomaha.com/eap

15 CONFIDENTIAL
401(k) Retirement Plan
You become eligible to participate in the Ankura 401(k) plan upon the completion of sixty days of employment. Ankura’s
401(k) plan is a Qualified Automatic Contribution Arrangement (QACA) plan. In the first half of the year following the
end of each calendar year, Ankura contributes 3% of your eligible wages up to IRS limits into your 401(k) account. This
benefit is provided whether you elect to contribute to the 401(k) or not. In addition, Ankura may make an annual
discretionary Profit Sharing Contribution (tied to company performance) of up to 4% of a participant's calendar-year
eligible compensation, regardless of the participant's contribution.
Please see vesting schedule below; your years of service are based on your original hire date. You are always 100%
vested in the personal contributions you make into your 401(k).
Register at www.mykplan.com

Employee Percent Vested

Years of Service Guaranteed 3% Discretionary
1 0% 0%
2 100% 20%
3 40%
4 60%
5 80%
6 100%

ADP 401(k) will send you a letter to your home address
confirming your eligibility and enrollment details.
Group Number: 238385
Administered through ADP Customer Service:
1-800-695-7526
Employee Contribution Options:
• 401(k) and/or Roth Pre-Tax Contributions: 1% to 90%.
• Roth 401(k): 1% to 90%.
• All employee contributions are immediately vested
at 100%.

Employer Contributions:
• IRS Limit: $19,000 (2020 calendar year).
• Are not per-pay matchings.
• Catch-Up Limit: $6,000 for employees 50 & over
(2020 calendar year). • Occur in the first half of the year following the close
of a plan year.
• Auto Enrollment: 3% will be deducted pre-tax from
your pay and invested in your plan's default fund • Vesting schedule above.
unless you opt out.

16 CONFIDENTIAL
COST OF MEDICAL COVERAGE

AETNA PPO PLAN – ANNUAL SALARY RANGE $0-$59,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $74.79 $37.39
Employee + Spouse: $149.57 $74.79
Employee + Child(ren): $109.94 $54.97
Employee + Family: $224.36 $112.18

AETNA LOW PLAN – ANNUAL SALARY RANGE $0-$59,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $52.55 $26.27
Employee + Spouse: $105.11 $52.55
Employee + Child(ren): $77.25 $38.62
Employee + Family: $157.66 $78.83

AETNA HIGH PLAN - ANNUAL SALARY RANGE $0-$59,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $35.23 $17.61
Employee + Spouse: $70.46 $35.23
Employee + Child(ren): $51.78 $25.89
Employee + Family: $105.68 $52.84

AETNA PPO PLAN - ANNUAL SALARY RANGE $60,000-$99,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $93.48 $46.74
Employee + Spouse: $186.97 $93.49
Employee + Child(ren): $137.42 $68.71
Employee + Family: $280.45 $140.23

AETNA LOW PLAN - ANNUAL SALARY RANGE $60,000-$99,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $65.69 $32.84
Employee + Spouse: $131.38 $65.69
Employee + Child(ren): $96.57 $48.28
Employee + Family: $197.07 $98.53

AETNA HIGH PLAN - ANNUAL SALARY RANGE $60,000-$99,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $44.03 $22.01
Employee + Spouse: $88.07 $44.03
Employee + Child(ren): $64.73 $32.36
Employee + Family: $132.10 $66.05

17 CONFIDENTIAL
COST OF MEDICAL COVERAGE

AETNA PPO PLAN - ANNUAL SALARY RANGE $100,000-$199,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $112.18 $50.09
Employee + Spouse: $224.36 $112.18
Employee + Child(ren): $164.90 $82.45
Employee + Family: $336.54 $168.27

AETNA LOW PLAN - ANNUAL SALARY RANGE $100,000-$199,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $78.83 $39.41
Employee + Spouse: $157.66 $78.83
Employee + Child(ren): $115.88 $57.94
Employee + Family: $236.49 $118.24

AETNA HIGH PLAN - ANNUAL SALARY RANGE $100,000-$199,999

Monthly Deduction Semi-Monthly Deduction
Employee Only: $52.84 $26.42
Employee + Spouse: $105.68 $52.84
Employee + Child(ren): $77.68 $38.84
Employee + Family: $158.52 $79.26

AETNA PPO PLAN - ANNUAL SALARY RANGE $200,000 AND ABOVE

Monthly Deduction Semi-Monthly Deduction
Employee Only: $130.88 $65.44
Employee + Spouse: $261.75 $130.88
Employee + Child(ren): $192.39 $96.19
Employee + Family: $392.63 $196.32

AETNA LOW PLAN - ANNUAL SALARY RANGE $200,000 AND ABOVE

Monthly Deduction Semi-Monthly Deduction
Employee Only: $91.97 $45.98
Employee + Spouse: $183.94 $91.97
Employee + Child(ren): $135.19 $67.59
Employee + Family: $275.90 $137.95

AETNA HIGH PLAN - ANNUAL SALARY RANGE $200,000 AND ABOVE

Monthly Deduction Semi-Monthly Deduction
Employee Only: $61.65 $30.82
Employee + Spouse: $123.30 $61.65
Employee + Child(ren): $90.62 $45.31
Employee + Family: $184.95 $92.47

18 CONFIDENTIAL
COST OF DENTAL, VISION & VOLUNTARY LIFE COVERAGE

AETNA HIGH PPO PLAN

Monthly Deduction Semi-Monthly Deduction
Employee Only: $8.59 $4.30
Employee + Spouse: $17.93 $8.96
Employee + Child(ren): $20.15 $10.07
Employee + Family: $31.69 $15.84

AETNA LOW PPO PLAN

(NOTE: The Aetna Low PPO dental plan has a zero-dollar cost to the employee, no matter which level of coverage is elected).
Monthly Deduction Semi-Monthly Deduction
Employee Only: $00.00 $00.00
Employee + Spouse: $00.00 $00.00
Employee + Child(ren): $00.00 $00.00
Employee + Family: $00.00 $00.00

VSP VISION PLAN

Monthly Deduction Semi-Monthly Deduction
Employee Only: $3.80 $1.90
Employee + Spouse: $6.40 $3.20
Employee + Child(ren): $6.54 $3.27
Employee + Family: $12.55 $6.28

VOLUNTARY LIFE/AD&D PLANS

Age Band Employee Rate Per $1,000 of benefit Spousal Rate Per $1,000 of benefit
<25 $0.040 $0.040
25-29 $0.040 $0.040
30-34 $0.044 $0.044
35-39 $0.055 $0.055
40-44 $0.084 $0.084
45-49 $0.143 $0.143
50-54 $0.237 $0.237
55-59 $0.370 $0.370
60-64 $0.576 $0.576
65-69 $1.035 $1.035
70-74 $1.853
75-79 $3.056
80+ $6.191
Employee AD&D $0.020
Spouse AD&D $0.020
Child Life $0.100
Child AD&D $0.020

19 CONFIDENTIAL
 Additional questions or need help?
Contact Ankura Benefits: 833-261-5443
Available 8 am – 8 pm EST

© 2019 Ankura Consulting Group, LLC