2013 U.S.

Benefits Highlights
1
Benefits Eligibility
Silver Spring Networks offers these benefits to active, full-time employees normally scheduled
to work at least 25 hours per week. Eligible employees may enroll themselves and eligible
dependents in benefits. You can cover yourself, your spouse, including a same gender domestic
partner
1
if the partnership is legally recognized by the state in which the license or certificate is
issued, and any dependent children up to age 26.

What Happens if You Dont Enroll
If you do not make any enrollment elections, you will only be enrolled in the Basic Life/AD&D
and Short and Long Term Disability plans.

Medical Coverage
As a participant in Silver Spring Networks benefits program, you may choose the medical plan
thats right for you and for your family. Your choices include:
Blue Shield PPO Plans Offers two PPO plans with varying levels of comprehensive
coverage and benefits for routine care with the freedom to obtain care from in- and out-of-
network providers. Includes a network of participating doctors, hospitals and other health
care providers. Your out-of-pocket expenses will be lower and you will receive a higher level
of coverage when you use PPO network providers.
Shield Savings Plus 1800 with Health Savings Account (HSA) Plan Similar in design
to the PPO plan, but allows you to pay for your deductible and eligible out-of-pocket
expenses using a Health Savings Account (HSA), which both you and Silver Spring
Networks can contribute money into. If funds in your HSA are not used in a year, they are
carried over to the next plan year. See page 7 for more details about this new medical plan
option.
Kaiser Permanente HMO Plan (California) Generally costs less money at the time you
seek services than a PPO plan, but requires you to receive all of your care and services
through the HMOs network providers.
Waive You can also choose to waive medical coverage.

1
A domestic partner is someone with whom you live in an exclusive, committed relationship and expect to do so indefinitely. You and your domestic partner
must consider themselves to be life partners, not be married to any other person, and be financially interdependent and can provide evidence if requested.
2
The chart below compares some of the main features of the medical plans so you can evaluate
them side-by-side. The percentages and copayments below reflect your responsibility.
Plan Feature
Blue Shield PPO
100/50 250
Blue Shield PPO
90/70 250
Shield Savings Plus 1800
w/HSA Plan *
Kaiser HMO
Plan
(California)
In-Network
Out-of-
Network
In-Network Out-of-Network
In-Network
Out-of-
Network

Providers You may use any licensed
provider but your out-of-pocket
costs will be less when you use
in-network providers
You may use any licensed
provider but your out-of-pocket
costs will be less when you use
in-network providers
You may use any licensed
provider but your out-of-pocket
costs will be less when you
use in-network providers
You must use
the HMOs
providers;
otherwise, the
Plan will not
pay benefits
Preventi ve Care: No charge 50% after
deductible
No charge 30% after
deductible
No charge Not Covered No charge
Annual Deductible
(Individual/Family)
$250/
$500
$500/
$1,000
$250/
$500
$1,800/
$3,600
$1,800/
$3,600
NA
Coinsurance No charge after
deductible
50% after
deductible
10% after
deductible
30% after
deductible
10% after
deductible
30% after
deductible
NA
Out-of-Pocket Max
(individual/family)
$2,000/
$4,000
$5,000/
$10,000
$2,000/
$4,000
$10,000/
$20,000
$4,000/
$8,000
$8,000/
$16,000
$3,000/
$6,000
Office Visits $20 copay
(no deductible)
50% after
deductible
$20 copay

30% after
deductible
10% after
deductible
30% after
deductible
$15 copay
Lab/x-ray $20 copay
after deductible
50% after
deductible
$20 copay

30% after
deductible
10%** after
deductible
30% after
deductible
$10 per
encounter
Outpatient
surgery
$100 per
surgery after
deductible
50%+all
charges in
excess of
$350 per day
10% after
deductible
30%+all
charges in
excess of $350
per day
10% after
deductible
30%+all
charges in
excess of
$350 per day
$15 per
procedure
Inpatient
hospitalization
$200 per admit
after deductible
50% after
deductible +
all charges in
excess of
$600 per day
10% after
deductible
30%+all
charges in
excess of $600
per day
10% after
deductible
30% after
deductible +
all charges in
excess of
$600 per day
$200 per admit
Emergency Room $100 per visit 10% after
deductible
10% after
deductible
10% after
deductible
10% after
deductible
$100 per visit
Chiropractic $25/visit
(12 visits/year)
50% after
deductible
(12 visits/year)
$25/visit
(12 visits/year)
50% after
deductible
(12 visits/year)
10% after
deductible
(20 visits/yr)
50% after
deductible
(20 visits/yr)
$15/visit
(20 visits/year)

*When enrolling dependents on the Shield Savings 1800 plan the full family deductible must be satisfied before the plan will pay.
**Lab/X-Ray performed in a hospital setting are subject to an additional $25 copay for basic lab/x-ray or a $100 copay for high cost procedures.
3
Health Savings Account (HSA) Medical Plan
When you enroll in the Shield Savings Plus 1800 with HSA Plan, you are able to use a HSA to
help you pay deductibles and eligible out-of-pocket expenses. This plan has lower premiums
and includes a portable savings account.
The basic concept behind the HSA Medical Plan is simply to encourage you to:
Take care of yourself, by providing full coverage for preventive care
Shop smart and share in the cost, when you need care
If you have a serious health issue, after you meet the deductible and reach your out-of-
pocket maximum, your eligible expenses are 100% covered.
Heres how it works:
1. Health Savings Account
Essentially, a Health Savings Account is similar to a personal bank account that both you and
Silver Spring Networks can contribute pre-tax money to. Then, when you need care, you can
use those funds to help pay for eligible medical expenses.
Silver Spring Networks will contribute the following pre-tax amounts to your HSA in 2013:
$900 if you enroll yourself
$1,800 if you enroll yourself and eligible dependents
You can also contribute to your HSA, up to the IRS maximum of $3,250 (individual) or $6,450
(family). These maximums include the amounts Silver Spring Networks contributes on your
behalf. If you are age 55 or older, you can also contribute up to $1,000 in catch-up
contributions each year.
Any pre-tax contributions you make to your HSA will be deducted from your pay in equal
installments throughout the year; likewise, Silver Spring Networks contribution is made per pay
period.
If you dont use all of the HSA funds
accumulated by year end, these funds
roll over for future use. There is no
limit to how much you can roll over
year to year. The result is that in
future years you may not necessarily
have to use your own money to meet
your deductible or even your out-of-
pocket maximum.
So over the long-term, you can
accumulate money in the HSA to help
pay for your future health care needs.
And, perhaps more importantly, you
can use the HSA to fund your long-
term health care needs such as
paying for health care coverage when
you are retired with tax-free money.
Thats because if you leave Silver Spring Networks, you take any money accumulated in your
HSA with you (HSA funds used for non-medical expenses will be subject to applicable taxes).
4
Questions about the HSA Medical Plan?
If you have questions about the HSA
Medical Plan or your benefits in general,
ClearBenefits representatives at
Helpdesk@clearbenefits.com or
(888) 423-6457.
BlueShield also offers helpful information
about the plan as well as consumer tools
and information to assist with pricing health
care services at www.blueshieldca.com.

2. Bridging the Deductible
The Plan has a deductible. This is the amount of expense that must be incurred before the Plan
begins paying traditional benefits. You can meet your deductible one of two ways: by paying for
it with after-tax out-of-pocket dollars or with money from your HSA.
In the first year you participate in the Plan, to meet your deductible you can use the money
Silver Spring Networks contributes to your HSA plus your own funds (either tax-free HSA funds
or after-tax dollars). However, if you roll over funds in your HSA from one year to the next, its
possible that in future years you will have enough money in your HSA to fully meet your annual
deductible.
3. Traditional Coverage
After the deductible is met, you pay a percentage of any additional medical services you receive
(coinsurance), up to your annual out-of-pocket maximum. The plan pays:
90% when you use network providers you pay the remaining 10%, and
70% when you use non-network providers you pay the remaining 30%
The HSA Plan uses the same Blue Shield network as currently offered under the PPO plan.
With the Plan as with more traditional medical
plans you are protected from significant financial
loss due to a serious medical situation. The plan
pays 100% once you reach the following out-of-
pocket maximums (including deductible &
coinsurance):
$4,000 individual/$8,000 family, when you use
in-network providers, and
$8,000 individual/$16,000 family, when you use
out-of-network providers

Important Considerations about the HSA Medical Plan
The IRS sets limits on the total HSA contributions allowed in a year - HSA contributions
cannot exceed $3,250 individual or $6,450 for you and your family. This includes the
amounts contributed by Silver Spring Networks and the funds that you contribute on a pre-
tax basis. If you are enrolled in the HSA plan for the entire calendar year and receive Silver
Spring Networks full annual contribution (funded on a per-pay period basis), you may
contribute up to $2,350 individual or $4,650 family.
HSAs are federally tax-free; however, they may be subject to state tax.
The money in your account earns interest that compounds tax-free.
If you and/or your spouse/domestic partner are age 55 or older, you may contribute more to
your HSA in a year than those under age 55. You are entitled to make additional catch-up
contributions of up to $1,000 in 2013.




5

Health Care Terms to Know
Annual Deductible The
amount you must pay before the
Plan begins paying benefits. The
deductible generally doesnt
apply, however, for services
subject to a copayment.
Coinsurance The percentage
amount both you and the Plan
pay when you obtain medical
and/or dental care. In general,
you must first meet your
deductible before the Plans
coinsurance payments begin.
Copayment A flat dollar
amount you pay when you obtain
certain services; copayments
generally apply when you obtain
your care from in-network
providers.
Health Savings Account (HSA)
A tax privileged account that
you and your employer can
contribute funds to on a pre-tax
basis. The funds may be used to
help pay for eligible health care
expenses.
Consumer-Driven Plan You
share in the responsibility of how
your health care dollars are
spent. Like the BlueShield HSA,
most consumer-driven plans have
a deductible to meet before
benefits are paid, but also provide
tools to educate you about health
care options and empower you to
take control of your health.
Bridge - The bridge is the
amount you need to pay after
you have used your available
HSA dollars (or if you choose not
to use your HSA dollars to pay
for covered services) before the
plan pays covered expenses.
You must pay the entire bridge
amount in order to satisfy your
plans deductible, before the
traditional health coverage
component of the plan begins.
Plan Lifetime Maximum The
maximum amount the Plan will
pay over the course of a covered
individuals lifetime.
Plan Annual Maximum The
maximum amount the Plan will
pay in any year toward the cost
of covered services.
Out-of-Pocket Maximum The
maximum amount you must pay
in a given Plan Year before the
Plan pays 100% of all remaining
eligible expenses. The out-of-
pocket maximum generally only
applies under the medical plans.
Usual and Customary (U&C)
The average dollar amount
health care providers charge for
a specific service within a
specific geographical area. If you
participate in the PPO medical
plan and use out-of-network
providers, youre responsible for
your portion of the U&C charge
(coinsurance), plus any amount
above U&C that the particular
provider charges.
6
Prescription Drugs
When you elect a medical plan option, you also receive prescription drug coverage. The chart
below shows what you can expect to pay for prescription drugs under the Blue Shield PPO
Plans, the Shield Savings Plus 1800 w/HSA Plan and the Kaiser Permanente HMO:
BlueShield
PPO Plans
Shield Savings Plus 1800
HSA Plan
Kaiser HMO
Plan
(California)
1

In-Network
Out-of-
Network
In-Network
Out-of-
Network
Retail
Prescription
Drugs
Up to 30-day
Supply
Generic: $10
Brand Formulary: $25
Brand Non-
Formulary: $40
Copay +25% Plan
Deductible
Applies, then
Generic: $10
Brand
Formulary:
$25
Brand Non-
Formulary:
$40
Plan
Deductible
Applies
Copay +25%
Generic: $10
Brand: $25

Mail Order
Prescription
Drugs
up to a 90-day
Supply
Generic: $20
Brand Formulary: $50
Brand Non-
Formulary: $80
Not Covered Plan
Deductible
Applies, then
Generic: $20
Brand
Formulary:
$50
Brand Non-
Formulary:
$80
Not Covered Generic: $20
Brand: $50
(up to a 100
day supply)
1
No benefits are paid for Kaiser members prescriptions filled through a non-HMO pharmacy
Using generic drugs and taking advantage of the plans mail order service can save you
money. Generic drugs contain the same active ingredients, safety, dosage, quality and strength
as their brand-name counterparts and are often sold under the chemical or scientific name for
the drug. They are often made by the same companies in the same factories, but the brand-
name versions can cost much more.
The prescription drug mail order option helps you spend less on your maintenance drugs such
as medication to treat high blood pressure, high cholesterol or thyroid conditions. Employees
using maintenance medications are encouraged to switch to the mail order program through the
vendor. To learn more or to sign up for the mail order program, contact the vendors: BlueShield
at www.blueshieldca.com or Kaiser at www.kaiserpermanente.org.

7
Dental Coverage
MetLife administers Sliver Spring Networks dental plan. Your dental plan benefits allow you to:
Visit any licensed dentist you choose (with the flexibility to select a different dentist for each
member of your family).
Save on out-of-pocket expenses when you visit an in-network Dental PPO dentist as such
dentists have agreed to charge plan participants no more than the (usually lower) negotiated
fee.
The following chart outlines the 2013 dental coverage benefits administered through MetLife.

Participating Providers*
Non-participating
Providers**
Annual Deductible None
$50 per person
$150 per family
Preventive and Diagnostic Care
Cleanings and Consultations
Plan pays 100% (no
deductible)
Plan pays 100% of R&C
(no deductible)
Basic Care
Fillings, Root Canals, and Oral Surgery
Plan pays 80% Plan pays 80%
Major Restorative Care
Bridges, Crowns, and Dentures
Plan pays 50% Plan pays 50%
Orthodontia Treatment
50%, lifetime max of
$1,500 per adult and/or
child
50%, lifetime max of
$1,500 per adult and/or
child
Annual Benefit Maximum
$1,750 per person,
excluding orthodontia
$1,750 per person,
excluding orthodontia
*The participating percentage of benefits is based on the discounted fee negotiated with the provider.
**The non-participating percentage of benefits is based on the Reasonable and Customary (R&C) charges for your geographic area

Vision Coverage
The Vision Plan, through VSP, provides comprehensive vision care coverage, paying benefits
both for regular eye exams and corrective eyewear (lenses and frames or contact lenses). The
plan does not provide benefits for cosmetic eye wear or corrective eye surgery, though
discounts may be available for some services. The following chart highlights the vision plan
coverage:
VSP Coverage*
Exams $20 copay; once every year
Glasses $25 copay; once every year
Lenses Every 12 months
Frames Up to $130, every 24 months
Contacts, in lieu of lenses and frames Up to $130, every 12 months
*VSP reimbursement amounts for using non-VSP providers varies. Please see Summary Plan Description for details.
8
Life and Accident Insurance
To help you provide for your family if something were to happen to you, Silver Spring Networks
provides you with a basic amount of Life and Accidental Death & Dismemberment (AD&D)
insurance coverage. You can purchase additional voluntary insurance for yourself and your
family. CIGNA is the carrier for these benefits.
The company pays the full cost of basic life insurance for you in the amount of two times your
base annual salary to a maximum of $500,000. Under the voluntary life insurance program, you
have the option of purchasing an increased benefit amount for yourself and your family.
You can purchase optional voluntary life and AD&D insurance, as follows:
$30,000 to $150,000 in increments of $30,000 for yourself
$25,000 for your spouse/domestic partner (employee coverage required)
$1,000 for dependents from birth to 6 months of age; $10,000 for dependents 6 months to
19 years old (employee coverage required).
For this year only, if you are currently enrolled in the employee voluntary life program and wish
to increase your level of coverage up to the Guarantee Issue amount, you will not need to
complete the online Evidence of Insurability (EOI) form. If you would like to enroll in the
voluntary life insurance program and have waived coverage in the past, full underwriting will not
be required.

Income Replacement
Disability insurance pays a portion of your income if you are unable to work for an extended
period of time due to pregnancy, personal illness or a non-work-related injury. The company
provides basic disability benefits at no cost to you.
Short-Term Disability
Company-paid basic short-term disability (STD) insurance, through CIGNA, pays a benefit of 60
percent of your weekly base salary up to $3,464 for up to 12 weeks (with 7 day waiting period).
You have to opportunity to elect a buy-up option to increase your income replacement for short-
term disability. This benefit is 100% employee paid. When you elect the buy-up option, your
short-term disability benefit increases your income replacement benefit to 66 2/3 percent of your
weekly base salary up to $3,464 for up to 12 weeks (with 7 day waiting period).
Long-Term Disability
Company-paid basic long-term disability insurance, through CIGNA, pays a benefit of 60
percent of your base salary, up to a maximum monthly benefit of $15,000. This amount is offset
by benefits from other sources, such as Social Security. Benefits begin after 90 days of disability
and can continue as long as your remain disabled up to your normal retirement age.
You have to opportunity to elect a buy-up option to increase your income replacement for long-
term disability. This benefit is 100% employee paid. When you elect the buy-up option, your
long-term disability increases your income replacement benefit to 66 2/3 percent of your
monthly base salary up to $15,000.

9
Sample Eligible FSA Expenses
Health Care
Some sample eligible Health Care FSA
expenses include, but are not limited
to:
Deductibles, coinsurance, and
copayments
Prescription eyeglasses and
sunglasses, or contact lenses and
associated supplies
Lasik surgery
Prescription drugs
Dependent Care
Eligible expenses include amounts you
pay for:
In-home child or elder care
services
Services provided by a day care
facility
Fees you pay for a specialty camp,
such as soccer or computer camp,
if the camp also serves as
necessary day care
Flexible Spending Accounts
Silver Spring Networks offers benefits that can help you save money on your taxes our tax-
free Flexible Spending Accounts or FSAs. You can use the FSAs to help pay for many health
care and dependent (i.e., child or elder) care expenses.
Participating in an FSA is voluntary, and you can participate in the FSAs even if you (or your
dependents) are not enrolled in any of Silver Spring Networks health care plans. Silver Spring
Networks offers two FSAs, the:
Health Care FSA: An account you can use to pay eligible health care expenses that are not
covered or fully covered by your Silver Spring Networks health care plans (such as
copayments, deductible and coinsurance amounts, and amounts spent on health care
expenses eligible for reimbursement under the FSA but not covered by any other health
care plans in which you are enrolled). Please note: If
you enroll in the Blue Shield HSA plan, you will not be
eligible to participate in the Health Care FSA.
Dependent Care FSA: An account you can use to pay
for dependent care expenses you incur on behalf of an
eligible dependent so that you (and your spouse) can
work, go to school full-time, or look for work.
How FSAs Work
Money you contribute to an FSA is not subject to federal
income or FICA (Social Security) taxes, or state income
taxes in most instances. They extend your buying power
because you pay less tax. Each year you specify how
much of your pay you want to put into each FSA. You can
select any whole dollar amounts up to the following
maximums:
Health Care FSA Yearly Maximum: $2,500
Dependent Care FSA Yearly Maximum: Up to $5,000
(depending on your marital and income-tax filing status;
$2,500 if married, filing separately)
Silver Spring Networks will deduct from your paycheck the
amount you elect to contribute, before taxes, in equal
amounts each pay period and deposited into your FSA
account(s).
When you have an eligible expense and a claim is
submitted to the FSA administrator, the money in your FSA
account is then used to reimburse you.
Some Important Rules for FSAs
For the Dependent Care FSA
2
, you are reimbursed up to the amount you currently have
deposited in the account. If your claim exceeds your current deposit, the excess will be held
until you have deposited enough money to cover it.

2
You can use the Dependent Care FSA to pay for the day care expenses you (or you and your spouse) incur in order to work, look for work or attend school.
Expenses must be incurred on behalf of an eligible dependent, generally a child up to the age of 13 or an elder who requires care and is dependent on you for
support.
10
For the Health Care FSA, however, you can claim up to the full amount of your annual
deposit as soon as you incur an eligible expense. You dont have to wait until the
contributions are actually in your account.
Once you have chosen the amount of your FSA deposit for the year, you cannot change
your mind until the next annual enrollment period unless you experience a qualified
change in status, such as a marriage or birth of a child.
Health Care and Dependent Care Flexible Spending Accounts are use it or lose it
accounts. That means that you have until December 31, 2013 to use the funds in your
account(s). If you dont use whats in your Health Care FSA or Dependent Care FSA by
December 31, 2013, you forfeit any money left in your account(s). Claims for expenses
incurred in the 2013 plan year must be submitted no later than March 31 of the following
year.
You are only able to receive reimbursement for expenses for certain over-the-counter
(OTC) medications if you have a prescription. Generally, this change only affects OTC
medicationsnot supplies. Certain OTC items are eligible without a prescription.
The following chart is not a complete list, but outlines examples that will or will not
require a prescription to receive reimbursement:

OTC Requiring Prescription OTC No Prescription Required
Allergy medications Contact lens supplies & solution
Cough, cold & flu medications Crutches
Pain relief medications Band-Aids & first-aid supplies
Sleep aids & sedatives Diabetic supplies (blood sugar test kits & Insulin)

Expenses for which you receive reimbursement from the FSAs cannot be claimed as a
deduction (health care) or credit (dependent care) on your income taxes.
Due to IRS regulations, you generally cannot use an FSA to pay expenses incurred on
behalf of a domestic partner or your partners children.
If you enroll in the BlueShield HSA plan for 2013, you will not be able to participate in the
Health Care FSA.
FSAs can be used only for expenses considered eligible by the IRS as determined by our FSA
administrator, Flex-Plan. For a listing of eligible expenses, visit their website at www.flex-
plan.com or the IRS Web site at www.irs.gov and look for Publications 502 and 503.
3


3
Please keep in mind that not all expenses eligible for reimbursement are considered eligible under the IRS-allowed health care deduction and dependent care
tax credit; therefore, there are differences between what is listed as an eligible expense in the IRS publications and what you may reimburse yourself for through
the FSAs. For example, you may use Health Care FSA funds to reimburse yourself for over-the-counter medications (with a prescription); however, such
expenses are not eligible for a tax deduction and thus are not listed as an eligible expense in the IRS publication.
11
Commuter Benefits
Silver Spring Networks offers commuter benefits that allow you to pay for work-related
transportation with before-tax dollars. The cost of commuting and/or parking is deducted from
your paycheck before payroll taxes are calculated, which saves you money on income tax and
FICA (Social Security). The commuter benefits are for use by employees who take public
transportation or ride a vanpool to get to work or who pay to park their cars in public lots at or
near their places of work, or to commute by public transportation.
A unique feature of commuter benefits is that you can participate in these accounts as you need
them. You can sign up for an entire year, or just one month at a time. Log onto the Flex-Plan
Services website at www.flex-plan.com to purchase transit and parking benefits or to learn more
about the program.
Employee Assistance Program (EAP)
The EAP or Life Assistance plan, administered by Cigna, is designed to help you manage lifes
challenges. Everyone needs a helping hand once in a while, and your EAP can provide it. It can
refer you to professional counselors and services that can help you resolve emotional health,
family and work issues. This benefit is provided at no cost to you, and is available to all
household members. There is no enrollment; and, you do not need to be enrolled in the Silver
Spring Network medical plans.
Resources available to you include:
Up to three (3) face-to-face meetings with a consultant per issue
Childcare and/or eldercare referrals
Personal relationship information
Health information and online tools
Legal consultations with licensed attorneys
Financial planning assistance
Stress management
Career development
Information about EAP is available by calling (800) 538-3543 or online at
www.Cignabehavioral.com/CGI (username: rewards; password: savings)
Hyatt Legal Plan
Whether youre buying a new home, drawing up a will, or just need some legal advice, Hyatt
Legal Plan can give you easy access to highly experienced, participating attorneys, plus a wide
range of covered legal services at an affordable cost of $9.75 per pay period. When you enroll
in the Hyatt Legal Plan, you are enrolling for the entire year. You can only make a change if you
experience a qualified change in status such as a marriage or birth. For more information call
(800) 821-6400 or go online to www.legalplans.com (select Thinking about Enrolling).

12
Your Semi-Monthly Contributions
This chart shows Silver Spring Networks and your semi-monthly premium contributions for the
2013 Plan Year.
Medical/Dental/Vision

Short-term & Long-term Disability Buy-up
The cost for Short-term and/or long term disability Buy-up is covered through post-tax payroll
deductions and varies based on your income and benefit eligibility.
Example:
An employee earns an annual salary of $115,000.
Buy-up Short-term Disability: $115,000 / 52 x 0.6667 =$1,474.43 total weekly benefit
$1,474.43 / $10 x $0.015 =$2.21 cost per pay period
Buy-up Long-term Disability: $115,000 / 12 =$9,583.33 of monthly base salary
$9,583.33 / $100 x 0.060 =$5.75 cost per pay period
Note: due to policy limitations, employees earning over $270,000 should use a $270,000 annual
salary to estimate their cost per pay period.



You
Only
You +
spouse/
domestic partner
You + Child
You +
Child(ren)
You + Family
Blue Shield PPO
(100/50 250)
$64.00 $157.00 $148.00 $148.00 $294.25
Blue Shield PPO
(90/70 250)
$33.00 $107.50 $102.00 $102.00 $192.50
Blue Shield
Plus 1800 HSA
Savings
$12.50 $45.00 $40.00 $40.00 $72.50
Kaiser HMO CA $13.25 $45.00 $42.50 $42.50 $61.00
Dental MetLife $2.50 $8.25 $8.25 $16.50 $16.50
Vision VSP $1.00 $1.50 $1.50 $3.00 $3.00

Employee Only You pay (semi-monthly)
Short-term Disability
Buy-up Option
$0.015 for each $10 of
weekly benefit
Long-term Disability
Buy-up Option
$0.060 for each $100 of
your monthly base salary
13
Voluntary Life and AD&D Insurance
The cost for Voluntary Life and Accidental Death and Dismemberment insurance is covered
through post-tax payroll deductions. The cost of the benefit varies based on your (or your
spouses/domestic partners) age, volume of coverage, and whether or not you are a tobacco
user. The chart below can be used to help you estimate your bi-weekly costs for Voluntary Life
and AD&D Insurance.
ADDITIONAL LIFE AND AD&D INSURANCE
Age Semi-monthly Rate / $1,000 of Coverage
Voluntary Life and AD&D
Insurance
Employee
non-tobacco user
Employee
tobacco user
Spouse
<25
$0.0175 $0.0260 $0.0390
25 29
$0.0195 $0.0290 $0.0190
30 34
$0.0235 $0.0350 $0.0265
35 39
$0.0320 $0.0510 $0.0420
40 44
$0.0435 $0.0765 $0.0620
45 49
$0.0695 $0.1215 $0.0970
50 54
$0.1070 $0.2060 $0.1500
55 59
$0.1765 $0.2930 $0.2275
60 64
$0.2860 $0.4455 $0.3785
65 69
$0.5075 $0.7530 $0.6310
70 74
$0.9175 $1.3255 $1.1220
75 or older
$1.8295 $2.3605 $2.3285

Voluntary Child
Life and AD&D
All Ages
$0.1160

Example:
A 38 year old non-tobacco user elects $90,000 of Life and AD&D coverage for himself; $25,000
for his 34 year old spouse; $10,000 for his 5 year old child.
Cost for employee =$90,000 / $1,000 x $0.0320 =$2.88 per pay period
Cost for spouse =$25,000 / $1,000 x $0.0265 =$0.66 per pay period
Cost for child =$10,000 / $1,000 x $0.1160 =$1.16 per pay period