Total Compensation Statement

As an employee of [Company name], you receive regular pay for the services you provide. The other part of your total compensation is the value of the benefits that [Company name] makes available to you and your family. The value of these benefits is your "hidden paycheck." This personalized benefits statement describes your hidden paycheck and is intended to give you a summary of the benefits you personally receive and their value.

If you find any inaccuracies or have questions concerning your benefits and this statement, please contact human resources.

Please realize that this personalized benefits statement is not a legal document. All benefits are governed by the actual benefit plans, which have precedence over the information reported in this statement. [Company name] reserves the right to change, suspend, or cancel its benefit policies or practices with or without notice.

Employee name: _________________________

Date of hire: _________________________

Current salary/rate: _________________________

Medical Benefits

You have elected [insert type/level] coverage for [medical, dental, vision]. [Company name] pays [percent] of the cost of coverage for a total of [amount] per month.

Medical Savings Accounts

Because you are enrolled in [Company name]'s high-deductible health plan, [Company name] contributes [percent] to a health savings account (HSA) in your name for a total of [amount] per month.

You have elected to contribute [amount] per pay period to your medical flexible spending account (FSA), which allows you to pay for your eligible health care expenses on a pre-tax basis. [Company name] contributes [percent] to the FSA for a total of [amount] per month.

Dependent Care Account

You have elected to contribute [amount] per pay period to your dependent care account, which allows you to pay for your eligible employment-related dependent care expenses on a pre-tax basis.

Paid Leave

For the calendar year beginning January 1, your leave benefits include:

Accrued vacation leave: _____________________

Accrual rate per pay period: _____________________

Accrued sick leave: _____________________

Accrual rate per pay period: _____________________

Holiday leave: _____________________

Personal days: _____________________

The total value of your paid leave for this calendar year (based on your current salary/wages) is [amount].

In addition, [Company name] has provisions for bereavement leave, jury duty leave, military leave and family and medical leave.

Disability Insurance

If you become disabled because of sickness or accident and are unable to work on a short-term basis, you are eligible to receive [percent] of your regular weekly wage up to a maximum of [amount]  per week. [Company name] pays [percent] of the short-term disability premium for a total of [amount] per month.

If you are unable to work for long periods of time because of sickness or accident, you are eligible to receive [percent] of your regular weekly wage up to a maximum of [amount] per week. [Company name] pays [percent] of the long-term disability premium for a total of [amount] per month.

Life Insurance

You have individual coverage for life insurance in the amount of [amount] times your annual salary. [Company name] pays [percent] of the premium cost for a total of [amount] per month.

Employee Assistance Plan

You are eligible to participate in this confidential service, which provides initial professional counseling, and referral services for employees who need emotional, financial, legal, and other types of counseling. [Company name] pays [percent] of the cost for this benefit for a total [amount] per month.

Social Security

{Company/Organization} contributes to and also forwards employee withholding taxes under FICA (Federal Insurance Contributions Act which includes Social Security and Medicare benefits) on your behalf. These benefits provide each working American with retirement income and also provide income security to employees in the event of disability, income security to surviving members of deceased workers' families, and hospital insurance for the aged and the disabled.

You may request a Personal Earnings and Benefit Statement (PEBES) from the Social Security Administration to verify your earnings records and receive an estimate of your future Social Security benefits.

Retirement

[Company name] sponsors a [type] retirement plan in which you participate. [Company name] made a matching contribution in the amount of [amount] for plan year [year]. [Company name] also made a discretionary year-end contribution in the amount of [amount] for plan year [year].  You receive a quarterly statement of your retirement benefits through this plan and may also access your personal account information online through [address].

TOTAL COMPENSATION

As you may have realized after reading the above, your total compensation is significantly higher than your annual salary or wages.

[Company name]'s cost for providing these benefits equals approximately [percent] of your salary/wages or [amount] per year.

As your length of employment increases with [Company name], additional years of service may further enhance the value of benefits, particularly your retirement benefits.