MEDICAL CONTRIBUTION SCHEDULE
Smoker Employee Pays (Per Pay Period)
Option 1 BlueCare 71
Non Smoker Employee Pays (Per Pay Period)
Total Monthly Cost
Employee Only
$ 530.77
$ 64.55
$ 87.62
Employee + Spouse
$1,263.22
$402.60
$425.68
Employee + Child(ren)
$ 976.61
$212.63
$235.70
Family
$1,655.98
$526.18
$549.26
Smoker Employee Pays (Per Pay Period)
Option 2 BlueOptions 5905
Non Smoker Employee Pays (Per Pay Period)
Total Monthly Cost
Employee Only
$ 586.59
$ 90.31
$113.39
Employee + Spouse
$1,396.09
$463.92
$487.00
Employee + Child(ren)
$ 1,079.32
$260.03
$283.11
Family
$1,830.16
$606.57
$629.65
Smoker Employee Pays (Per Pay Period)
Option 3 BlueCare 54
Non Smoker Employee Pays (Per Pay Period)
Total Monthly Cost
Employee Only
$ 579.14
$ 86.87
$109.95
Employee + Spouse
$1,378.35
$455.74
$478.81
Employee + Child(ren)
$1,065.61
$253.70
$276.78
Family
$1,806.91
$595.84
$618.92
Smoker Employee Pays (Per Pay Period)
Option 4 BlueCare 52
Non Smoker Employee Pays (Per Pay Period)
Total Monthly Cost
Employee Only
$ 585.28
$ 89.70
$112.78
Employee + Spouse
$1,392.95
$462.48
$485.55
Employee + Child(ren)
$1,076.90
$258.91
$281.99
Family
$1,826.05
$604.68
$627.75
4
Made with FlippingBook - Online catalogs