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
$150.00
$120.00
No Cost
No Cost
$373.35
$280.00
Employee + Spouse
$464.38
No Cost
Employee + Child(ren)
$286.90
$214.10
$180.00
No Cost
Family
$693.60
$599.18
$492.00
No Cost
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MOTHER BENEFITS GUIDE
CONTRIBUTIONS I
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