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    General Business Information




    Benefit Plan Selections

    Life, Accidental Death and Dismemberment (AD&D) and Dependent Life

    Plan Design

    Description

    Life and AD&D

    $25,000 of Group Life Insurance, and an additional $25,000 of Accidental Death and Dismemberment Insurance

    Dependent Life

    $10,000 Spouse
    $5,000 for each dependent child

    Extended Health Care Coverage

    Please select one.

    Plan Design

    Description

    Extended Health Care Plan Design 1

    • Unlimited overall maximum

    • Drug Plan 80% plan

    • Professional Services @ 80%

    Extended Health Care Plan Design 2

    • Unlimited overall maximum

    • Drug Plan 100% plan

    • Professional Services @ 100%

    Dental Care Coverage

    Optional.

    Plan Design

    Description

    Dental Care Plan Design 1

    • Maximum $1,000/year

    • Basic & Supplementary @ 80%

    • 2 per calendar year

    Dental Care Plan Design 2

    • Maximum $1,000/year

    • Basic & Supplementary @ 100%

    • 2 per calendar year

    Employee Data

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