Blue Care Network HMO
|
Type:
|
Medical
|
|
Coverage:
|
Family
|
Dependents:
|
Name
|
Relationship
|
|
|
Jane A. Adams
|
(Spouse)
|
|
|
Jill A. Adams
|
(Child)
|
|
|
Ralph A. Adams
|
(Child)
|
|
|
Penelope Adams
|
(Child)
|
|
|
|
1/1/2000
|
$162.63
|
$91.23
|
Delta DMO Plan
|
Type:
|
Dental
|
|
Coverage:
|
Family
|
|
Employee PCP ID: OKS2141
|
Dependents:
|
Name
|
Relationship
|
PCP ID
|
|
Jane C. Adams
|
(Spouse)
|
OKS2141
|
|
Jill A. Adams
|
(Child)
|
OKS2141
|
|
Ralph A. Adams
|
(Child)
|
OKS2141
|
|
Penelope Adams
|
(Child)
|
OKS2141
|
|
|
1/1/2000
|
$21.74
|
$24.15
|
Vision Service Plan
|
Type:
|
Vision
|
|
Coverage:
|
Family
|
Dependents:
|
Name
|
Relationship
|
|
|
Jane C. Adams
|
(Spouse)
|
|
|
Jill A. Adams
|
(Child)
|
|
|
Ralph A. Adams
|
(Child)
|
|
|
Penelope Adams
|
(Child)
|
|
|
|
1/1/2000
|
$11.45
|
$12.65
|
Short Term Disability
|
Type:
|
STD
|
|
Coverage:
|
$10,000 (Base)
|
|
Total Amount:
|
$10,000
|
|
Dependents:
|
N/A
|
|
1/1/2000
|
$2.00
|
$2.00
|
Long Term Disability
|
Type:
|
LTD
|
|
Coverage:
|
1 x Salary (Base)
|
|
Total Amount:
|
$10,000
|
|
Dependents:
|
N/A
|
|
1/1/2000
|
$2.00
|
$2.00
|
Basic Life Plan
|
Type:
|
Basic Life
|
|
Coverage:
|
1 x Salary (Base)
|
|
Total Amount:
|
$47,424.00
|
|
Dependents:
|
N/A
|
|
1/1/2000
|
$0.00
|
$4.00
|
Basic AD&D Plan
|
Type:
|
Basic AD&D
|
|
Coverage:
|
5 x Salary + $1,000 (Base) + $1,000
|
|
Total Amount:
|
$10,000
|
|
Dependents:
|
N/A
|
|
1/1/2000
|
$2.00
|
$2.00
|
401k
|
Type:
|
Retirement
|
|
Contribution:
|
10%
|
Investment
Options:
|
|
20%
|
Union Planters Bank
|
|
20%
|
Aetna Fixed Plus Account
|
|
20%
|
Calvert Income Fund
|
|
20%
|
Fidelity Retirement Government Market Fund
|
|
20%
|
Fidelity OTC Portfolio
|
|
|
1/1/2000
|
$58.00
|
|
