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Allcom Global Services, Inc.
9
2015-2016 Monthly Employee Cost
Medical
BASE
BUY UP
ENRICHED
Employee
$62.04
$92.66
$99.44
Employee & Spouse
$455.55
$524.73
$563.98
Employee & Child(ren)
$431.62
$496.25
$533.37
Family
$796.61
$874.93
$940.47
Dental
Employee
$32.61
Employee & Spouse
$66.60
Employee & Child(ren)
$65.25
Family
$94.85
Vision
Employee
$4.72
Employee & Spouse
$8.96
Employee & Child(ren)
$9.20
Family
$12.27
Employee
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Employee
Monthly Cost
Spouse
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Spouse Monthly
Cost
Child(ren)
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Child(ren)
Monthly Cost
Life EnrollmentWorksheet