Medical Basic Plan	$120.00 01/01/
You Pat Morgan Cameron
	Tobacco Surcharge I do not use tobacco products	$0.00 01/01/
You Pat
	Working Spouse Surcharge My working spouse is eligible for other coverage	$0.00 01/01/
You
	Dental DMO Plan	$40.00 01/01/
You Pat Morgan Cameron
	Vision Standard Plan	$21.50 01/01/
You Pat Morgan Cameron
	Healthcare Flexible Spending Account No coverage	$0.00 01/01/
You
	Dependent Care Flexible Spending Account No coverage	$0.00 01/01/
You
	Basic Life 5 x Base Pay, $250,000	$17.50 01/01/
You
	Supplemental Life Insurance 3 x Base Pay, $150,000	$10.50 01/01/
You
	Spouse Life Insurance $20,000	$10.20 01/01/
You
	Child Life Insurance $5,000	$2.50 01/01/
You
	Short-Term Disability No coverage	$0.00 01/01/
You
	Long-Term Disability 40% of Base Pay, $20,000	$5.00 01/01/
You
	Critical Illness No coverage	$0.00 01/01/
You Pat
	Accident Insurance Coverage, You + Family	$40.00 01/01/
You

	Per-Pay-Period Cost	You	Pat	Morgan	Cameron
Medical High Deductible Health Plan	$229.29 01/01/
Health Savings Account (HSA) Enrolled	$38.20 01/01/
Biometric Surcharge Surcharge	$0.00 01/01/
Biometric Surcharge - Spouse Surcharge	$0.00 01/01/
Tobacco Surcharge Surcharge	$0.00 01/01/
Biometric Surcharge - Spouse Surcharge	$0.00 01/01/
Engagement Penalty Engagement Penalty	$5.00 01/01/
Dental DMO Plan	$26.11 01/01/
Vision Standard Plan	$3.08 01/01/
Limited Purpose Spending Account (LPSA) No coverage	$0.00 01/01/
Health Care Spending Account (HCSA) No coverage	$0.00 01/01/
Dependent Care Spending Account (DCSA) No coverage	$0.00 01/01/
Basic Life Insurance 1.5 x Annual Rate Coverage = $236,000	$17.50 01/01/
Group Universal Life No coverage	$0.00 01/01/
Basic AD&D 1.5 x Annual Rate Coverage = $236,000	$0.00 01/01/
Supplemental AD&D 3 x Annual Rate	$0.00 01/01/
Short-Term Disability 100% STD Plan	$0.00 01/01/
Long-Term Disability Base Monthly Pay	$5.00 01/01/
Hyatt Legal No coverage	$0.00 01/01/
Total	$327.15
Before-Tax	$276.34
After-Tax	$50.81