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7. Does your company prepare individualized annual benefit statements <br />reflecting the value of all benefits; e.g., salary, retirement, sick leave, <br />insurance, etc.? Yes No <br />If Yes, indicate the associated costs: <br />a. Initial set -up fee <br />b. Per statement fee <br />8. Describe any other special programs, additional products or enhancements <br />beyond those requested in the RFP that this proposal included for the benefit <br />of the City employees. <br />DENTAL <br />1. Cost of Dental Services for December 1, 2001 through November 30, 2002. <br />Cost Component <br />Employee Only <br />Full Family <br />Dental Plan Option #1 <br />$50 Deductible <br />100% Preventative <br />80% Basic Services <br />50% Major Services <br />50% Orthodontia <br />$1,000 Annual Maximum <br />(Non Orthodontia) <br />$1,000 Lifetime Maximum <br />Orthodontia <br />2. Indicate any variations from the current coverages included in the plan(s) proposed: <br />3. Describe any dental care limitation or restrictions. Do not refer the City to a specimen <br />contact or booklet. <br />4. Is coverage Portable? <br />5. If Yes, at same premium? <br />6. Describe any other special programs, additional products or enhancements beyond those <br />requested in the RFP that this proposal included for the benefit of the City <br />employees. <br />VISION <br />Page 15 of 17 <br />Dental, Life, LTD, Vision RFP.Doe <br />