Medical Plans (Every wk)
Choose either Plan 1 , Plan 2 or Waive Coverage
Plan 1: Non H.S.A. Plan
Employee - $37.00
Employee and Child(ren) - $112.00
Employee and Spouse - $144.00
Employee and Family - $215.00
Plan 2: H.S.A. Plan
Employee - $25.00
Employee and Child(ren) - $99.00
Employee and Spouse - $130.00
Employee and Family - $197.00
Medical Wavier
I am waiving the Medical Coverage offered and will receive $50.00 per pay from Mast Trucking, Inc. I understand that if I waive coverage for myself and/or dependent(s) at this time, I will not be eligible for coverage in these plans until open enrollment, unless I have a qualified status change.
Dental (Max of 4/mo)
Dental Plan
Employee - $6.99
Employee and One Dependent - $13.66
Employee and Family - $19.80
Dental Wavier
I am waiving the Dental Coverage offered. I understand that if I waive coverage for myself and/or dependent(s) at this time, I will not be eligible for coverage in these plans until open enrollment, unless I have a qualified status change.
Vision (Max of 4/mo)
Vision Plan
Employee - $1.43
Employee and Child(ren) - $2.13
Employee and Spouse - $2.13
Employee and Family - $3.60
Vision Wavier
I am waiving the Vision Coverage offered. I understand that if I waive coverage for myself and/or dependent(s) at this time, I will not be eligible for coverage in these plans until open enrollment, unless I have a qualified status change
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