$200
$250
$300
$500
$1,500
Employee 1 Only
Employee 1 & Spouse
Employee 1 & Child
Employee 1 & Family
Employee 2 Only
Employee 2 & Spouse
Employee 2 & Child
Employee 2 & Family
Employee 3 Only
Employee 3 & Spouse
Employee 3 & Child
Employee 3 & Family
Employee 4 Only
Employee 4 & Spouse
Employee 4 & Child
Employee 4 & Family
Employee 5 Only
Employee 5 & Spouse
Employee 5 & Child
Employee 5 & Family
Employee 6 Only
Employee1 & Spouse
Employee 6 & Child
Employee 6 & Family
Employee 7 Only
Employee 7 & Spouse
Employee 7 & Child
Employee 7 & Family
Employee 8 Only
Employee 8 & Spouse
Employee 8 & Child
Employee 8 & Family
Employee 9 Only
Employee 9 & Spouse
Employee 9 & Child
Employee 9 & Family
Employee 10 Only
Employee 10 & Spouse
Employee 10 & Child
Employee 10 & Family
Employee 11 Only
Employee 11 & Spouse
Employee 11 & Child
Employee 11 & Family
Employee 12 Only
Employee 12 & Spouse
Employee 12 & Child
Employee 12 & Family
Employee 13 Only
Employee 13 & Spouse
Employee 13 & Child
Employee 13 & Family
Employee 14 Only
Employee 14 & Spouse
Employee 14 & Child
Employee 14 & Family
Employee 15 Only
Employee 15 & Spouse
Employee 15 & Child
Employee 15 & Family