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Enrollment Preparation Worksheet <br /> ICurrent Election New Election <br /> Medical ' Florida Blue Florida Blue <br /> 5770 / 5772 / 5774 5770 / 5772 / 5774 <br /> Tier EE ES ECH FAM $ EE ES ECH FAM $ <br /> Flex Spending Chard-Snyder Chard-Snyder <br /> Medical$ Medical$ <br /> Dependent Care$ Dependent Care$ <br /> Dental Cigna Dental Cigna Dental <br /> High PPO / Low PPO / DHMO High PPO / Low PPO / DHMO <br /> Tier EE ES ECH FAM $ EE ES ECH FAM $ <br /> Vision United Healthcare UnitedHealthcare <br /> Option 1 / Option 2 Option 1 / Option 2 <br /> Tier EE ES ECH FAM $ EE ES ECH FAM $ <br /> Life Insurance The Standard The Standard <br /> Employee Coverage$ Employee Coverage$ <br /> Deduction$ Deduction$. <br /> Spouse Coverage$ Spouse Coverage$ <br /> Deduction$ Deduction$ <br /> Child(ren)Coverage$ Child(ren)Coverage$ <br /> Deduction$ Deduction$ <br /> Short Term Disability, Cigna Disability Cigna Disability <br /> Monthly Benefit$ Monthly Benefit$ <br /> Deduction$ Deduction$ <br /> Long Term Disability Cigna Disability Cigna Disability <br /> Weekly Benefit$ Weekly Benefit$ <br /> Deduction$ Deduction$ <br /> Accident/Critical <br /> Illness/Cancer MetLife MetLife <br /> • <br /> Accident Accident <br /> EE ES ECH FAM $ EE ES ECH FAM $ <br /> Critical Illness Critical Illness <br /> EE ES ECH FAM $ EE ES ECH FAM $ <br /> Cancer Cancer <br /> EE ES ECH FAM $ EE ES ECH FAM $ <br /> Legal&Identity LegalShield Only LegalShield Only <br /> Theft Protection <br /> EE ES ECH FAM $ EE ES ECH FAM $ <br /> IDShield Only IDShield Only <br /> EE ES ECH FAM .$ EE ES ECH FAM $ <br /> Combo Plan Combo Plan <br /> EE ES ECH FAM $ EE ES ECH FAM $ • <br /> EE=Employee ES=Employee&Spouse ECH=Employee&Child(ren) FAM=Family <br /> 76 <br /> 41 <br />