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SAMPLE CAFETERIA PLAN DESIGN <br /> <br />City Contribution <br /> <br />Required Benefits <br /> Employee Health - $750 Deductible <br /> Employee Dental <br /> Employee Life Insurance - $25,000 <br /> Balance Available after Required Benefits <br /> <br />X <br /> <br />Voluntary Options <br /> Optional Medical <br /> Employee - $200 Deductible <br /> Employee - $15 Copay <br /> Employee & Spouse - $750 Deductible <br /> Employee & Spouse - $200 Deductible <br /> Employee & Spouse - $15 Copay <br /> Employee & Children - $750 Deductible <br /> Employee & Children - $200 Deductible <br /> Employee & Children - $15 Copay <br /> Family - $750 Deductible <br /> Family - $200 Deductible <br /> Family - $15 Copay <br /> <br />Optional Dental <br />Family <br /> <br />Other Optional Benefits <br />Supplemental Employee Life Insurance <br />Dependent Life Insurance <br />Long Term Disability <br />Short Term Disability <br />Flexible Spending Accounts <br /> Dependent Care Reimbursement <br /> Medical Expense Reimbursement <br />Deferred Compensation - 457 plan <br /> <br />Total Optional Benefits <br /> <br />Notes: <br /> <br />The city's contribution is set annually by the City Council. <br />The contribution amount may be the same for all employees <br /> or differ depending on the health insurance selected - <br /> employee, family or other. <br /> <br /> <br />