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2011 INSURANCE OPTIONS PLAN 1 - SINGLE COVERAGE

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$750 Deductible ---- Maximum Out of Pocket Expense $1,650

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Single Plan 1
Medical Only
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

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Medical$5,532.00$5,997.56($465.56)$1.00per Year

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Single Plan 1
with Single Vision
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

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Medical$5,532.00

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Vision$125.40

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Total$5,657.40$5,997.56($340.16)$1.00per Year

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Single Plan 1
with Single Dental
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

.

Medical$5,532.00

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Dental$245.16

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Total$5,777.16$5,997.56($220.40)$1.00per Year

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Single Plan 1
with Single Vision & Dental
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

.

Medical$5,532.00

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Dental$245.16

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Vision$125.40

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Total$5,902.56$5,997.56($95.00)$1.00per year