Individual Choice Benefits ... At a Glance

Plan	Choices	Payment Method
Medical Insurance	choose between two medical options OR decline coverage if you have coverage elsewhere	benefit credits and, if required, before-tax dollars
Dental Insurance	choose the dental option OR decline dental coverage1	benefit credits and, if required, before-tax dollars
Employee Life Insurance	must choose at least one unit choose coverage in $20,0002 units up to $200,000, but not to exceed 10 times annual salary	benefit credits and, if required, first $50,000 of coverage paid with before-tax dollars; amount over $50,000 paid with after-tax dollars
Dependent Life Insurance	choose between two dependent life insurance options OR decline dependent life insurance coverage	benefit credits and, if required, after-tax dollars
Accident Insurance	choose coverage in $20,000 units up to $300,000 OR decline accident insurance coverage	benefit credits and, if required, after-tax dollars
Long-Term Disability Insurance	choose between two options after eligibility is established	benefit credits and, if required, after-tax dollars
Health Care Flexible Spending Account	choose to deposit up to $4,000 OR decline to participate	benefit credits and/or before-tax dollars
Dependent Care Flexible Spending Account	choose to deposit up to $5,0003 OR decline to participate	benefit credits and/or before-tax dollars
Health Savings Account (You *must* be enrolled in the High Deductible Health Plan to elect a Health Savings Account)	choose to deposit up to the amount of the high deductible health plan’s deductible4 OR decline to participate	benefit credits and/or before-tax dollars

¹If you do not enroll in dental coverage when you are first eligible or if you drop dental coverage during any subsequent enrollment period, you will not be eligible to enroll again until the second enrollment period following your refusal of coverage.

²Coverage amounts will be reduced based on age beginning at 65. Refer to the Age Reduction Rule.

³The maximum contribution to a dependent care flexible spending account is $5,000. If you are married and file separate tax returns, the maximum contribution allowed is $2,500 per individual.

⁴The maximum contribution to a health savings account includes any employer contribution.