Type of Plan	Single	+One	Family
Health Net HMO $20 OV/ $10/20/35 RX	$435.63	$936.60	$1,285.08
Health Net Low $25 ov/$500 per day Hospital $15/30/50 RX	$360.67	$775.41	$1,063.94
Kaiser (Vision included) $20 OV/ $10/$25 RX	$491.76	$983.52	$1,391.68
Kaiser Low $20 OV/ $500 Deductible/20% Hospital $10/$30 RX	$396.38	$792.76	$1,121.76
Delta Dental $2,000.00 per year	$96.00	$96.00	$96.00
Vision Service Plan (VSP)	$29.65	$29.65	$29.65
Blue Shield Life Insurance ($10,000)	$3.60

 

Negotiated Monthly Benefit Cap
Full Time: (7 or 8 hours per day)	$387.00
6 hours per day	$290.25
5 hours per day	$241.88
4 hours per day	$193.50
Less than 4 hours per day	- 0 -

 

Your Cap ___________

Your Cost _____________

 

Total the costs of your choice of benefits and subtract your negotiated cap. The result is your monthly cost for your health and welfare selections.