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View Benefit Costs - per month Plan Employee Employee + Spouse Employee + Child(ren) Family Medical HMO Blue Care Network HMO $90.80 $172.92 $162.63 $384.36 Cigna Health $51.17 $166.50 $211.28 $376.08 Infinity Resources, Inc. PPO $41.0 $143.50 $198.81 $321.91 Medical PPO Cigna Flexcare EPP $0.00 - - $0.00 Infinity Resources, Inc. PPO $10.00 - - $10.00 Plan Employee Employee + Spouse Employee + Child(ren) Family Dental PPO Delta Preferred Option $0.00 $25.36 $21.74 $53.13 Delta Dental PMI $0.00 $10.00 $20.00 $30.00 Plan Employee Employee + Spouse Employee + Child(ren) Family Vision Vision Service $0.00 $7.00 $14.00 $26.00 Plan Cost Structure Basic AD&D Basic AD&D $0 Basic Life Basic Life $0 Voluntary AD&D Voluntary AD&D Note: $0.25 per $1,000 of benefit (monthly) Voluntary Life Voluntary Life View Plan Cost Structure File Plan Cost Structure Long Term Disability Long Term Disability View Plan Cost Structure File Note: $0.25 per $1,000 of benefit (monthly) Short Term Disability Short Term Disability View Plan Cost Structure File Note: $0.25 per $1,000 of benefit (monthly) Plan Cost Structure Additional Cancer Insurance View Plan Cost Structure File

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