MEDICAL CONTRIBUTION SCHEDULE
LOW Health Network Only Open Access
Employee Pays (Per Pay Period)
Employer Contribution (Per Pay Period)
Total Monthly Cost
Employee Only
$ 45.98 $230.74 $175.30 $353.32
$210.62 $318.38 $278.88 $390.81
$ 555.97 $1,189.77 $ 984.06 $1,612.30
Employee + Spouse Employee + Child(ren)
Family
MID Health Network Only Open Access
Employee Pays (Per Pay Period)
Employer Contribution (Per Pay Period)
Total Monthly Cost
Employee Only
$ 77.91 $300.42 $228.59 $456.68
$247.92 $396.85 $348.13 $488.22
$ 705.96 $1,510.77 $1,249.56 $2,047.30
Employee + Spouse Employee + Child(ren)
Family
HIGH Health Network Option Open Access
Employee Pays (Per Pay Period)
Employer Contribution (Per Pay Period)
Total Monthly Cost
Employee Only
$105.24 $338.08 $261.30 $493.95
$259.90 $443.32 $385.00 $564.96
$ 791.15 $1,693.04 $1,400.32 $2,294.31
Employee + Spouse Employee + Child(ren)
Family
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