2015 Benefits Options
Spectrum Membership ($50/month)
Insurance
Dental Insurance
Select....
Yes
No
Dental Insurance for
Select....
Employee - $42.14/month
Employee+Spouse - $95.24/month
Employee+Children - $90.15/month
Employee+Family - $145.81/month
Vision Insurance
Select....
Yes
No
Vision Insurance for
Select....
Employee - $11.01/month
Employee+Spouse - $22.02/month
Employee+Children - $20.92/month
Employee+Family($30.56)
Health Insurance
Select....
Yes
No
Health Insurance for
Select....
Employee - Included
Employee+Dependent(1) - $275/month
Employee+Family - $600/month
Life Insurance
Select....
Yes
No
Total amount
Add up each amount and put the total here. Include $50 Spectrum fee.