Employee Cost Coverage through UMR and Surest Bi-Weekly Premiums Base Coverage through Davis Network Coverage through Delta Dental Buy-Up Coverage through VSP Network Bi-Weekly Premiums MEDICAL Bi-Weekly Premiums DENTAL VISION Base Buy-Up Surest Base Buy-Up Employee Only $0.00 $0.00 $0.00 Base Buy-Up Employee Only $0.00 $0.00 Employee + Employee Only $0.00 $0.00 Spouse $0.00 $0.00 $0.00 Employee + Spouse $0.00 $0.00 Employee + Spouse $0.00 $0.00 Employee + Employee + Child(ren) $0.00 $0.00 Child(ren) $0.00 $0.00 $0.00 Employee + Child(ren) $0.00 $0.00 Family $0.00 $0.00 Family $0.00 $0.00 $0.00 Family $0.00 $0.00 SEE THIS PLAN SEE THIS PLAN SEE THIS PLAN