MEDICAL CONTRIBUTION SCHEDULE
Employee Contribution 2018 – 2019 Coverage Year
Employer Paid Benefit Amount Monthly
Employer Paid Benefit Amount Annually
BASE Choice Plus FQ3
Employee Only
$0.00 $0.00 $0.00 $0.00
$ 562.12 $1,202.94 $1,059.71 $1,787.31
$ 6,745.44 $14,432.28 $12,716.52 $21,447.72
Employee + Spouse
Employee + Child(ren)
Family
Employee Contribution 2018 – 2019 Coverage Year
Employer Paid Benefit Amount Monthly
Employer Paid Benefit Amount Annually
BUY-UP Choice Plus FXT
Employee Only
$29.75 $63.67 $56.09 $94.60
$ 691.05 $1,478.85 $1,302.77 $2,197.25
$ 6,745.44 $14,432.28 $12,716.52 $21,447.72
Employee + Spouse
Employee + Child(ren)
Family
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