| Coverage
Review |
|
|
Per
Pay Period Cost |
| Benefit
|
Your
Current Choices |
Effective
Date |
Pre-Tax
|
Post-Tax
|
|
| Medical |
Aetna POS Staff
Only |
07/01/2006
|
$22.00 |
$0.00 |
| Dental |
Staff Dental Plan
Staff Only |
07/01/2006
|
$3.50 |
$0.00 |
| Health Care Spending
Account |
Per Pay Period Contribution
|
07/01/2006
|
$0.00 |
$0.00 |
| Dependent Care Spending
Account |
Per Pay Period Contribution
|
07/01/2006
|
$0.00 |
$0.00 |
| Basic Life Insurance
|
$50,000 |
07/01/2006
|
$0.00 |
$0.00 |
| Supplemental Life
Insurance |
2 x Basic Benefits
Salary Non-smoker |
07/01/2006
|
$0.00 |
$3.05 |
| Spousal Life Insurance
|
Waive Coverage No
Coverage |
07/01/2006
|
$0.00 |
$0.00 |
| Dependent Child(ren)
Life Insurance |
Waive Coverage |
07/01/2006
|
$0.00 |
$0.00 |
| Voluntary AD&D
Insurance |
$ 400,000 |
07/01/2006
|
$0.00 |
$2.00 |
| Spousal AD&D
Insurance |
Waive Coverage |
07/01/2006
|
$0.00 |
$0.00 |
| Dependent Child(ren)
AD&D Insurance |
Waive Coverage |
07/01/2006
|
$0.00 |
$0.00 |
| Short-Term Disability
Insurance |
Coverage |
07/01/2006
|
$0.00 |
$0.00 |
| Long-Term Disability
Insurance |
60% of Basic Benefits
Salary $76,300.00 |
07/01/2006
|
$0.00 |
$4.16 |
| Business Travel Accident
Insurance |
$ 200,000 |
07/01/2006
|
$0.00 |
$0.00 |
| Effect on Your
Paycheck: |
|
|
|
Total Pre-Tax
Deductions |
|
$25.50
|
|
|
|
Total Post-Tax
Deductions |
|
|
$9.21
|