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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

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