.

2011 INSURANCE OPTIONS PLAN 3 - FAMILY COVERAGE

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$1,000 Deductible --- Maximum Out of Pocket Expense $3,000

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Family Plan 3
Medical Only
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

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Medical$15,648.00$9,133.00$6,515.00$6,515.00per Year

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$271.46per 24 pays

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$361.95per 18 pays

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Family Plan 3
with Single Vision
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

.

Medical$15,648.00

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Vision$125.40

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Total$15,773.40$9,133.00$6,640.40$6,640.40per Year

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$276.69per 24 pays

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$368.92per 18 pays

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Family Plan 3
with Single Dental
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

.

Medical$15,648.00

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Dental$245.16

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Total$15,893.16$9,133.00$6,760.16$6,760.16per Year

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$281.68per 24 pays

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$375.57per 18 pays

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Family Plan 3
With Single Dental & Vsion
Annual
Cost
Corporation
Contribution
Difference between
Annual Cost &
Corp Contribution
Employee
Pays

.

Medical$15,648.00

.

Dental$245.16

.

Vision$125.40

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Total$16,018.56$9,133.00$6,885.56$6,885.56per Year

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$286.90per 24 pays

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$382.54per 18 pays