MEDICAL CONTRIBUTION SCHEDULE
BlueCare OA HMO Plan NFQ54
Employee Pays (Weekly)
Employee Only
$ 37.06 $156.00 $109.46 $219.78
Employee + Spouse
Employee + Child(ren)
Family
BlueCare OA HMO Plan NFQ51
Employee Pays (Weekly)
Employee Only
$ 42.69 $169.38 $119.81 $237.32
Employee + Spouse
Employee + Child(ren)
Family
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