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Division of Purchase and Property
 
Notice of Award
Term Contract(s)
 
T-2794
DENTAL PROGRAM
DIVISION OF PENSIONS & BENEFITS

Vendor Information
By Vendor
RFP Documents
Email to STEPHANIE LUPINACCI

Downloadable NOA Documents
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NOAs By Number NOAs By Title Search NOAs
 
Index #:
T-2794
Contract #: VARIOUS
Contract Period: FROM:   01/01/15   TO:   12/31/19
Applicable To: SELECTED STATE AGENCIES
Cooperative Purchasing: NOT APPLICABLE
Vendor Name & Address: SEE VENDOR INFORMATION SECTION
For Procurement Bureau Use:  
Solicitation #: 23076
Bid Open Date: 10/02/13
CID #: 1041164
Commodity Code: 953-48
Set-Aside: SMALL BUSINESS SUBCONTRACTING

CONDITIONS AND METHODS OF OPERATION

Multi-Source Contracts: State Agencies and Cooperative Purchasing partners should review each vendor's product/service and prices carefully and place orders in accordance with the terms and conditions of the contract. Note that

A. Delivery: All prices F.O.B. Destination
B. Method of Operation - State Agencies Only:
Issue an agency purchase order to the appropriate contract vendor(s).

In the event of an emergency, contact the following in the order listed:

STEPHANIE LUPINACCI PROCUREMENT SPECIALIST 609-292-0250
LINDA SPILDENER PROCUREMENT SPECIALIST SUPERVISOR 609-633-3906
     
  PUB DATE: 11/17/17

VENDOR INFORMATION
Vendor Name & Address:
AETNA LIFE INSURANCE & ANNUITY
COMPANY
151 FARMINGTON AVE
HARTFORD, CT 06156
Contact Person: TAMI POLSONETTII
Contact Phone: 860-273-0123
Order Fax: 860-636-6178
Contract#: 87818
Expiration Date: 12/31/19
Terms: NONE
Delivery: SPECIFIED ELSEWHERE
Small Business Enterprise: NO
Minority Business Enterprise: NO
Women Business Enterprise: NO
Cooperative Purchasing *: NO
* WILL VENDOR EXTEND CONTRACT PRICES TO COOPERATIVE PURCHASING PARTICIPANTS?
 
Vendor Name & Address:
CIGNA HEALTH AND LIFE
INSURANCE COMPANY (CHLIC)
900 COTTAGE GROVE RD
BLOOMFIELD, CT 06152
Contact Person: JOAN MASTROPAOLO
Contact Phone: 201-533-7736
Order Fax: 201-533-7150
Contract#: 87822
Expiration Date: 12/31/19
Terms: NONE
Delivery: SPECIFIED ELSEWHERE
Small Business Enterprise: NO
Minority Business Enterprise: NO
Women Business Enterprise: NO
Cooperative Purchasing *: NO
* WILL VENDOR EXTEND CONTRACT PRICES TO COOPERATIVE PURCHASING PARTICIPANTS?
 
Vendor Name & Address:
HORIZON HEALTHCARE DENTAL INC
3 PENN PLAZA EAST
NEWARK, NJ 07105
Contact Person: JOSEPH J ALBANO
Contact Phone: 973-466-5200
Order Fax: 000-000-0000
Contract#: 87821
Expiration Date: 12/31/19
Terms: NONE
Delivery: SPECIFIED ELSEWHERE
Small Business Enterprise: NO
Minority Business Enterprise: NO
Women Business Enterprise: NO
Cooperative Purchasing *: NO
* WILL VENDOR EXTEND CONTRACT PRICES TO COOPERATIVE PURCHASING PARTICIPANTS?
 
Vendor Name & Address:
INTERNATIONAL HEALTHCARE
SERVICES
333 EARIE OVINGTON BLVD
SUITE 300
UNIONDALE, NY 10463
Contact Person: F D GIOVANNI
Contact Phone: 516-542-2683
Order Fax: 516-228-1734
Contract#: 87820
Expiration Date: 12/31/19
Terms: NONE
Delivery: SPECIFIED ELSEWHERE
Small Business Enterprise: NO
Minority Business Enterprise: NO
Women Business Enterprise: NO
Cooperative Purchasing *: NO
* WILL VENDOR EXTEND CONTRACT PRICES TO COOPERATIVE PURCHASING PARTICIPANTS?
 
Vendor Name & Address:
METROPOLITAN LIFE INS CO
501 ROUTE 22
BRIDGEWATER, NJ 08807
Contact Person: STEPHEN SOTTILE
Contact Phone: 908-253-6206
Order Fax: 908-253-2132
Contract#: 87819
Expiration Date: 12/31/19
Terms: NONE
Delivery: SPECIFIED ELSEWHERE
Small Business Enterprise: NO
Minority Business Enterprise: NO
Women Business Enterprise: NO
Cooperative Purchasing *: NO
* WILL VENDOR EXTEND CONTRACT PRICES TO COOPERATIVE PURCHASING PARTICIPANTS?
 

CONTRACT ITEMS/SERVICES BY VENDOR
Vendor:  AETNA LIFE INSURANCE & ANNUITY
COMPANY
Contract Number:  87818
UNLESS SPECIFIED OTHERWISE BELOW:
SHIP TO: 822140 / S001
PENSIONS/NEWSLETTER
C/O CAPITOL POST OFFICE
1321 BRUNSWICK AVE
TRENTON NJ 08625-0625
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00001 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 1
1.000 EACH N/A $20.14000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00002 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $57.33000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00003 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $35.05000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00004 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $42.48000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00005 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 1
1.000 EACH N/A $20.98000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00006 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $59.71000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00007 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $36.50000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00008 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $44.25000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00009 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00010 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00011 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00012 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00013 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00014 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00015 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00016 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00017 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00018 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00019 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00020 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00021 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00022 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00023 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00024 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00025 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00026 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00027 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00028 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00029 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00030 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00031 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DOP
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00032 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED 3.9% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00033 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00034 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00035 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00036 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00037 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00038 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00039 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00040 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00041 COMM CODE:  948-46-087275
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
ACTIVE
YEAR 1
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00042 COMM CODE:  948-46-087276
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
RETIRED
YEAR 1
1.000 EACH N/A $1.55000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00043 COMM CODE:  948-46-087275
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
ACTIVE
YEAR 2
1.000 EACH N/A $1.55000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00044 COMM CODE:  948-46-087276
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
RETIRED
YEAR 2
1.000 EACH N/A $1.55000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00045 COMM CODE:  948-46-087275
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
ACTIVE
YEAR 3
1.000 EACH N/A $1.62000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00046 COMM CODE:  948-46-087276
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
RETIRED
YEAR 3
1.000 EACH N/A $1.62000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00047 COMM CODE:  948-46-087275
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
ACTIVE
YEAR 4
1.000 EACH N/A $1.69000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00048 COMM CODE:  948-46-087276
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
RETIRED
YEAR 4
1.000 EACH N/A $1.69000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00049 COMM CODE:  948-46-087275
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
ACTIVE
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00050 COMM CODE:  948-46-087276
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
DENTAL EXPENSE PLAN
ADMINISTRATIVE SERVICES ONLY FEE PM/PM
RETIRED
YEAR 5
1.000 EACH NET N/A
 
Vendor:  CIGNA HEALTH AND LIFE
INSURANCE COMPANY (CHLIC)
Contract Number:  87822
UNLESS SPECIFIED OTHERWISE BELOW:
SHIP TO: 822140 / S001
PENSIONS/NEWSLETTER
C/O CAPITOL POST OFFICE
1321 BRUNSWICK AVE
TRENTON NJ 08625-0625
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00001 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM -SINGLE
DPO
YEAR 1
1.000 EACH N/A $20.96000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00002 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $59.62000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00003 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $36.46000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00004 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $44.19000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00005 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 1
1.000 EACH N/A $22.98000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00006 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $78.72000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00007 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $43.86000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00008 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $69.85000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00009 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00010 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00011 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00012 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00013 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00014 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00015 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00016 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00017 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00018 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00019 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00020 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00021 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00022 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00023 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00024 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00025 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00026 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00027 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00028 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00029 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00030 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00031 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00032 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED 4.5% INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00033 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00034 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00035 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00036 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00037 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00038 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00039 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00040 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 EACH NET N/A
 
Vendor:  HORIZON HEALTHCARE DENTAL INC Contract Number:  87821
UNLESS SPECIFIED OTHERWISE BELOW:
SHIP TO: 822140 / S001
PENSIONS/NEWSLETTER
C/O CAPITOL POST OFFICE
1321 BRUNSWICK AVE
TRENTON NJ 08625-0625
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00001 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 1
1.000 TASK N/A $20.16000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00002 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 1
1.000 TASK N/A $57.29000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00003 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 TASK N/A $35.03000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00004 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 TASK N/A $42.44000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00005 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 1
1.000 TASK N/A $20.76000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00006 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 1
1.000 TASK N/A $59.01000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00007 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 TASK N/A $36.08000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00008 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 TASK N/A $43.71000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00009 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $0.40 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00010 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $1.15 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00011 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $0.70 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00012 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $0.85 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00013 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $0.42 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00014 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $1.18 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00015 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $0.72 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00016 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $0.87 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00017 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $0.41 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00018 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $1.17 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00019 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $0.71 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00020 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $0.87 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00021 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $0.42 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00022 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $1.20 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00023 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $0.74 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00024 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $0.89 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00025 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $0.74 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00026 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $2.09 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00027 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $1.28 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00028 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $1.55 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00029 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $0.76 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00030 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $2.15 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00031 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $1.31 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00032 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $1.59 INCREASE.
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00033 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 5
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00034 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 5
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00035 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00036 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00037 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 5
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00038 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 5
1.000 TASK NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00039 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 TASK N/A $1.00000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00040 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 TASK NET N/A
 
Vendor:  INTERNATIONAL HEALTHCARE
SERVICES
Contract Number:  87820
UNLESS SPECIFIED OTHERWISE BELOW:
SHIP TO: 822140 / S001
PENSIONS/NEWSLETTER
C/O CAPITOL POST OFFICE
1321 BRUNSWICK AVE
TRENTON NJ 08625-0625
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00001 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 1
1.000 EACH N/A $8.78000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00002 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $24.95000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00003 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $15.27000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00004 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $18.49000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00005 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 1
1.000 EACH N/A $8.78000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00006 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $24.95000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00007 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $15.27000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00008 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $18.49000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00009 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $8.78 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00010 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $24.95 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00011 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $15.27 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00012 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $18.49 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00013 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $8.78 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00014 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $24.95 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00015 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $15.27 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00016 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2
PREMIUM NOT TO EXCEED A $18.49 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00017 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $8.78 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00018 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $24.95 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00019 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $15.27 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00020 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $18.49 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00021 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $8.78 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00022 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $24.95 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00023 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $15.27 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00024 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3
PREMIUM NOT TO EXCEED A $18.49 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00025 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $8.78 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00026 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $24.95 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00027 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $15.27 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00028 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $18.49 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00029 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $8.78 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00030 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $24.95 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00031 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $15.27 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00032 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
PREMIUM NOT TO EXCEED A $18.49 INCREASE.
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00033 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00034 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00035 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00036 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00037 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00038 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00039 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00040 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 EACH NET N/A
 
Vendor:  METROPOLITAN LIFE INS CO Contract Number:  87819
UNLESS SPECIFIED OTHERWISE BELOW:
SHIP TO: 822140 / S001
PENSIONS/NEWSLETTER
C/O CAPITOL POST OFFICE
1321 BRUNSWICK AVE
TRENTON NJ 08625-0625
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00001 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 1
1.000 EACH N/A $15.76000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00002 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $43.10000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00003 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $26.70000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00004 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $32.16000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00005 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 1
1.000 EACH N/A $15.76000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00006 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 1
1.000 EACH N/A $43.10000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00007 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 1
1.000 EACH N/A $26.70000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00008 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 1
1.000 EACH N/A $32.16000
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00009 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00010 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00011 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00012 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00013 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00014 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00015 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00016 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 2-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00017 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00018 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00019 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00020 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00021 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00022 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00023 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00024 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 3-PREMIUM NOT TO EXCEED 4% INCREASE
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00025 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00026 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00027 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00028 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00029 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00030 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00031 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00032 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 4
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00033 COMM CODE:  948-46-087267
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00034 COMM CODE:  948-46-087268
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00035 COMM CODE:  948-46-087269
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00036 COMM CODE:  948-46-087270
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
ACTIVE - PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00037 COMM CODE:  948-46-087271
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - SINGLE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00038 COMM CODE:  948-46-087272
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - FAMILY
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00039 COMM CODE:  948-46-087273
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED - PREMIUM - EMPLOYEE AND SPOUSE
DPO
YEAR 5
1.000 EACH NET N/A
LINE#  DESCRIPTION/MFGR/BRAND EST QUANTITY UNIT % DISCOUNT UNIT PRICE
00040 COMM CODE:  948-46-087274
[HEALTH RELATED SERVICES (SEE CLASS 952...]
 
ITEM DESCRIPTION:
RETIRED- PREMIUM - EMPLOYEE & CHILD(REN)
DPO
YEAR 5
1.000 EACH NET N/A


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