EMPLOYEE CONTRIBUTIONS
MONTHLY EMPLOYEE CONTRIBUTIONS
Monthly Contributions
Medical Plan 1 PPO Plan
Medical Plan 2 EPO Plan
Medical Plan 3 Base EPO Plan
Medical Plan 4 HSA Plan
Coverage Tier
Employee Only
$211.05
$157.67
No Cost
No Cost
Employee + Spouse
$1,055.24
$630.67
$579.71
$609.01
Employee + Child(ren)
$339.78
$253.84
$233.33
$222.26
Family
$914.89
$759.43
$698.06
$664.94
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SUPERBLOOM BENEFITS GUIDE
CONTRIBUTIONS I
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