DPA - Benefits - Consolidated Benefits

The following worksheet will help you calculate whether you will have monthly out-of-pocket premium costs deducted from your paycheck or be eligible to receive CoBen Cash in your paycheck each month. An automated worksheet is available at the Department of Personnel Administration's (DPA) website at www.dpa.ca.gov, Employee Benefits/Consolidated Benefits area.

1.	Enter the amount of your CoBen allowance. Refer to Your CoBen Allowance table.	$________
2.	Refer to the 2008 Benefit Plan Premiums table, identify your health and dental plans, and enter their appropriate total premium amounts.
HEALTH PLAN - (plan name) _____________________________ (total premium)		$ _________
DENTAL PLAN - (plan name) _____________________________ (total premium)		$ _________
VISION PLAN		$___9.19___
3.	Total Cost of your premiums - - - - - - - - - - - - - - - - - - - - - -
4.	Subtract the total cost of your premiums (Line 3) from your CoBen allowance (Line 1)	$ _________

If the amount on line 4 is a positive number, you'll receive this amount of taxable income each month. It will be noted on your paycheck as CoBen Cash. If the amount is a negative number, this is your net monthly out-of-pocket premium cost for the benefits you've selected. This amount will be deducted from your paycheck on a pre-tax basis.