|
|
|
|
|
|
|
| CommunityCare: Std Option HMO Plan |
$772.34 |
$1,876.76 |
$2,262.92 |
$2,494.62 |
$1,158.50 |
$1,390.20 |
| CommunityCare: Alt Option HMO Plan |
$532.66 |
$1,294.34 |
$1,560.68 |
$1,720.46 |
$799.00 |
$958.78 |
| GlobalHealth: Std Option HMO Plan |
$366.56 |
$967.78 |
$1,160.90 |
$1,275.74 |
$559.68 |
$674.52 |
| GlobalHealth: Alt Option HMO Plan |
$333.26 |
$879.84 |
$1,055.46 |
$1,159.82 |
$508.88 |
$613.24 |
| PacifiCare Std Option HMO Plan |
$686.42 |
$1,673.36 |
$2,016.32 |
$2,222.22 |
$1,029.38 |
$1,235.28 |
| PacifiCare Alt Option HMO Plan |
$473.39 |
$1,154.02 |
$1,390.53 |
$1,532.53 |
$709.90 |
$851.90 |
| HealthChoice High |
$449.48 |
$1,132.22 |
$1,360.42 |
$1,484.30 |
$677.68 |
$801.56 |
| HealthChoice Basic |
$391.64 |
$990.12 |
$1,191.94 |
$1,300.92 |
$593.46 |
$702.44 |
| HealthChoice USA |
$688.82 |
$1,377.64 |
$1,603.86 |
$1,726.50 |
$915.04 |
$1,037.68 |
| HealthChoice S-Account |
$382.56 |
$945.30 |
$1,135.48 |
$1,237.20 |
$572.74 |
$674.46 |
|
|
|
|
|
|
|
| Dental |
Employee |
Employee & Spouse |
Employee, Spouse & Child |
Employee, Spouse & Children |
Employee & Child |
Employee & Children |
|
|
|
|
|
|
|
| Assurant Heritage Plus Prepaid |
$11.74 |
$20.60 |
$28.20 |
$35.80 |
$19.34 |
$26.94 |
| Assurant Freedom Preferred |
$28.83 |
$57.50 |
$79.00 |
$115.30 |
$50.33 |
$86.63 |
| Assurant Heritage Secure Prepaid |
$7.20 |
$13.18 |
$18.38 |
$23.56 |
$12.40 |
$17.58 |
| CIGNA Dental Prepaid |
$9.26 |
$15.32 |
$22.40 |
$30.64 |
$16.34 |
$24.58 |
| Delta Dental PPO-POS |
$31.14 |
$62.28 |
$89.38 |
$130.84 |
$58.24 |
$99.70 |
| Delta's Choice PPO |
$13.94 |
$45.58 |
$77.48 |
$123.00 |
$45.84 |
$91.36 |
| Delta Dental Premier |
$35.52 |
$71.04 |
$101.94 |
$149.24 |
$66.42 |
$113.72 |
| HealthChoice Dental |
$29.84 |
$59.68 |
$84.56 |
$124.24 |
$54.72 |
$94.40 |
|
|
|
|
|
|
|
| Vision |
Employee |
Employee & Spouse |
Employee, Spouse & Child |
Employee, Spouse & Children |
Employee & Child |
Employee & Children |
|
|
|
|
|
|
|
| CompBenefits |
$6.76 |
$11.82 |
$15.39 |
$16.28 |
$10.33 |
$11.22 |
| PVCS |
$9.25 |
$17.25 |
$25.75 |
$28.00 |
$17.75 |
$20.00 |
| Spectera |
$8.18 |
$13.97 |
$18.56 |
$20.95 |
$12.77 |
$15.16 |
| Superior |
$6.98 |
$13.88 |
$20.48 |
$20.48 |
$13.58 |
$13.58 |
| VSP |
$8.76 |
$14.63 |
$20.25 |
$27.27 |
$14.38 |
$21.40 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
| Benefit Allowance |
Base Amount |
Dependent |
Benefit Allowance |
Life |
$4.56 |
| Employee |
$603.29 |
|
$603.29 |
Disability |
|
$9.10 |
| Plus Child |
$603.29 |
$215.71 |
$819.00 |
Supplemental Life |
$4.56 |
| Plus Children |
$603.29 |
$342.52 |
$945.81 |
|
|
|
| Plus Spouse |
$603.29 |
$632.87 |
$1,236.16 |
Dependent Life |
|
| Spouse & 1 Child |
$603.29 |
$848.58 |
$1,451.87 |
Low Option |
$2.60 |
| Spouse & 2 Children |
$603.29 |
$975.39 |
$1,578.68 |
Standard Option |
$4.32 |