Benefit Rates (Per pay)

Medical

	Base Plan	Mid Plan	Buy Up Plan
Employee Only	$65.36	$81.96	$191.04
Employee + Spouse	$134.47	$165.91	$447.58
Employee + Child(ren)	$107.94	$138.30	$399.47
Family^*	$182.45	$229.23	$570.66

Dental – PPO

	Rate
Employee Only	Free
Employee + Spouse	$14.74
Employee + Child(ren)	$21.44
Family	$41.35

Vision

	Rate
Employee Only	Free
Employee + Spouse	$3.23
Employee + Child(ren)	$3.59
Family	$6.97

Legal Insurance ARAG

	Per Pay Rate
Basic Coverage	$9.58
Expanded Coverage	$11.19

Voluntary Life and AD&D

per $1,000

Age	Life	AD&D
Under 20	$0.025	$0.009
20-24	$0.025	$0.009
25-29	$0.025	$0.009
30-34	$0.033	$0.009
35-39	$0.050	$0.009
40-44	$0.075	$0.009
45-49	$0.145	$0.009
50-54	$0.245	$0.009
55-59	$0.399	$0.009
60-64	$0.594	$0.009
65-69	$0.910	$0.009
70-74	$1.333	$0.009
75-79	$2.438	$0.009
80-84	$2.438	$0.009
85-89	$2.438	$0.009
90-94	$2.438	$0.009
95-99	$2.438	$0.009
Dependent Child	$0.078	$0.009

All costs are per pay bi-weekly