Employee Benefits

1. ABC Company
2016 Annual Salary $60,000
2016 Commissions
2016 Incentive Payment $776
Total Pay $60,776
Benefit
ABC
Company
Cost
Your Cost
Medical $10,293 $3,196
Dental $357 $46
Base Life $69
Short Term Disability $2,093
Long Term Disability $165
Voluntary Life $998
401(k) Employer Contribution $1,730
401(k) Employer Match $577
401(k) Employee Contribution $1,730
FICA $4,401 $4,401
Unemployment Tax $139
Workers Comp Insurance
Premium
$152
Total Benefits Cost $19,976 $10,372
Benefits Cost Breakdown 65.8% 34.2%
Total Compensation (Pay +
Benefits)
$80,752
This Statement has been
prepared for:
John Adams
Based on the following:
Date of Hire: 8/22/2011
Job Title: Coding Consultant
Department: Claims
Annual PTO Accrual: 168 Hours
Value of Annual PTO: $4,702
Value of 10 Holidays: $2,236
“ABC Company will improve the
health of our members through
innovative services and
partnerships across communities.”
-The ABC Company Mission
Dear John,
As an ABC Company employee, you receive regular pay for
performing your job. But there’s more to your compensation
than just your pay. The other part of your total compensation
is the value of the benefits that ABC Company makes
available to you and your family. This personalized benefits
statement describes your 2016 total compensation and gives
you a summary of the benefits you personally received and
their value.
Please contact Human Resources if you have questions
about your statement.
John Adams
123 Main Street
Anytown, MN 55123

2. Medical and Vision Dental
All regular employees with an appointment of at least a .5 FTE are
eligible for ABC Company’s medical coverage. This self-funded
medical plan is administered by PreferredOne, which offers a
network of physicians, clinics and hospitals included in the Open
Access Network 200.
All regular employees with an appointment of at least a .5 FTE are
eligible for ABC Company’s dental coverage. This self-funded
dental plan is administered by HealthPartners. Participants may
choose from one of three tiers of providers. The three provider tiers
are: Benefit Level 1 providers, Benefit Level 2 providers or out-of-
network providers.
Life Insurance Short and Long Term Disability
ABC Company provides you with a basic life insurance policy. This
benefit, which is provided to you at no cost, covers you at your
annual salary with a minimum of $50,000 and a maximum of
$200,000.
The company paid Accidental Death & Dismemberment coverage
amount matches your basic life coverage amount and is also
provided to you at no cost.
ABC Company also offers you the opportunity to purchase
additional life insurance for yourself and your dependents at low
discounted rates. Our records indicate that you currently have
elected additional life insurance coverage for yourself and your
dependent child or children.
These programs are for your protection in the event you become
disabled as a result of non-occupational accident or sickness.
Short Term Disability
 Pays 100% of your weekly earnings
 Benefits begin on the 1
st
day of a covered accident or on the 8
th
day of a covered illness
 Benefits may last up to six months
Long Term Disability
 If you are still totally disabled under the terms of the Long Term
Disability policy after six months, you may be entitled to receive
75% of your monthly earnings
401(k) FICA
All employees over the age of 19 with at least 90 days of tenure are
eligible to participate in the ABC Company sponsored 401(k)
Retirement Savings Plan. It’s not only a great way to prepare for
the future, but it also allows you to defer taxes through pre-tax
contributions.
ABC Company will also contribute 3% of your salary towards your
retirement savings account. Additionally, ABC Company will match
50% on the first 2% of your contributions up to a maximum match
of 1% of your salary.
Social Security & Medicare payroll taxes are collected under the
authority of the Federal Insurance Contributions Act (FICA),
consistent with prevailing law.
ABC Company contributes on your behalf: Social Security taxes of
6.2% on your first $113,700 of wages and Medicare takes 1.45% on
your total wages.
Detailed information about your personal Social Security benefits
can be obtained by calling the U.S. Government’s Social Security
Administration at (800) 772-1213 or by visiting their website at
www.ssa.gov/mystatement.
Important Facts About Your Summary
In preparing this personalized summary, we have made every effort to ensure the information depicted is accurate. The actual
documents and summary plan descriptions which govern your benefit plans are formal and complex and this type of summary can
only present an overview of your benefit package. In the case of any conflict or omission, the legal Plan Documents must prevail.