Overview of Cobra Benefit Costs 2024 Plan Year Details UMR Medical Monthly Premiums Base Buy-Up Surest PPO Employee Only $0,00 $0,00 $0,00 Employee + Spouse $0,00 $0,00 $0,00 Employee + Child(ren) $0,00 $0,00 $0,00 Family $0,00 $0,00 $0,00 Delta Dental Monthly Premiums Base Buy-Up Employee Only $0,00 $0,00 Employee + Spouse $0,00 $0,00 Employee + Child(ren) $0,00 $0,00 Family $0,00 $0,00 Guardian Vision Monthly Premiums Base Buy-Up (Davis Network) (VSP Network) Employee Only $0,00 $0,00 Employee + Spouse $0,00 $0,00 Employee + Child(ren) $0,00 $0,00 Family $0,00 $0,00 Page 4 | ACME | Plan Year 2024 Open Enrollment This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.