The Current Plan Design
Page 19

         • $0 Deductible with 80% coinsurance

         • Coinsurance Out of Pocket = $1,750 single
            and $5,250 family •$10/$30/$50 Rx Copay and $30 DOC
            (copays not included in out of pocket max)
         • The employer pays 100% of the employee premium
         • The employee pays 100% of dependent premium
         • **There are a total of 42 employees eligible
            of which 5 are double insured

Table of Contents

• 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8 • 9 • 10 • 11 • 12 • 13 • 14 • 15 • 16 • 17 •
• 18 • 19 • 20 • 21 • 22 • 23 • 24 • 25 • 26 • 27 • 28 • 29 • 30 • 31 •
• 32 • 33 • 34 • 35 • 36 • 37 • 38 • 39 • 40 • 41 • 42 • 43 • 44 • 45 •
• 46 • 47 • 48 • 49 •