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BENEFITS OVERVIEW

Your Benefit Options Provider Your Cost*
Medical HMO health plans
PPO health plans
Anthem and Kaiser Cost varies based on coverage level elected and your MOU
Cash-In-Lieu City None. Pays you up to $100** each month.
Dental PPO dental plan
DHMO dental plan
Delta Dental Coverage varies based on
coverage level elected
Preventive Only dental plan None. Pays you up to $5**
each month
Vision In-Network Blue View Vision
PLUS
Included at no cost
Out-of-Network reimbursements
Support Plus Employee and Family Assistance
counseling services
Optum Included at no cost
Life Insurance and Accidental Death & Dismemberment (AD&D) Life - Basic Coverage ($50,000 for full-time, $25,000 for half-time) MetLife Included at no cost
Life - Supplemental Coverage
(up to 7x your annual salary)***
Included at no cost
Life - Spouse/Domestic Partner
Coverage (up to $250,000)
Cost varies based on coverage level elected and is calculated by age and income.

See your personalized Benefit Statement or log in to your account at keepingLAwell.com for your specific cost details
Life - Child Coverage
(up to $20,000 per child)
Accidental Death & Dismemberment
(AD&D) (up to $500,000)
Disability Insurance Disability - Basic Coverage (up to 50% of earnings for a maximum of 2 years) The Standard
Insurance Company
Disability - Supplemental Coverage (up to 66-2/3% of earnings until retirement age)
Tax-Advantaged
Spending Accounts
Healthcare Flexible Spending Account (FSA) Ameriflex You elect voluntary contributions up
to an annual maximum limit:

- HCFSA: $3,200
- DCRA: $5,000
Dependent Care Account (DCA)
Transit and Parking Accounts WageWorks

* Your personal cost options are detailed in your Personalized Benefit Statement. They are
also available by logging in to your Benefits Central Account.

** Amounts represent full-time employment status. For half-time employees, the benefit is
reduced 50%.

*** Not to exceed $1 million in coverage