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BASE%MEDICAL%PLAN
BCBST
Employee(Only
$40.87
$166.81
$125.94
Employee(+(Spouse
$94.00
$350.31
$256.31
Employee(+(Child(ren)
$74.79
$305.27
$230.48
Employee(+(Family
$124.04
$506.28
$382.24
PREMIUM%MEDICAL%PLAN
BCBST
Employee(Only
$57.21
$191.49
$134.28
Employee(+(Spouse
$132.42
$402.15
$269.73
Employee(+(Child(ren)
$104.70
$350.44
$245.74
Employee(+(Family
$173.64
$581.19
$407.55
PRINCIPAL%DENTAL%PLAN
Employee(Only
$3.64
$14.57
$10.93
Employee(+(Spouse
$8.36
$33.43
$25.07
Employee(+(Child(ren)
$8.02
$32.09
$24.07
Employee(+(Family
$13.52
$54.08
$40.56
VSP%VISION%PLAN
Employee(Only
$0.87
$3.49
$2.62
Employee(+(1
$1.40
$5.59
$4.19
Employee(+(Children
$1.43
$5.71
$4.28
Employee(+(Family
$2.30
$9.20
$6.90
Agility%Fuel%Systems%also%provides%$15,000%of%term%life%insurance%and%shortKterm%and
%longKterm%disability%coverage%at%no%cost%to%you.
PLAN%COSTS%as%of%April%1,%2016
Agility%Fuel%Systems%will%continue%paying%a%portion%of%the%medical,%dental%and%
vision%plan%premiums%for%you%and%your%dependents.
Portion%of%BiKWeekly%
Premium%Paid%by%Agility
Employee%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
BiKWeekly%Cost
Total%BiKWeekly%
Premium