MEDICAL CONTRIBUTION SCHEDULE
Option 1 Choice BJ77
Employee Pays (Weekly)
Employee Only
$ 36.51 $ 153.69 $ 107.83 $ 216.52
Employee + Spouse Employee + Child(ren)
Family
Option 2 Choice AQQ4
Employee Pays (Weekly)
Employee Only
$ 46.07 $176.44 $125.42 $246.34
Employee + Spouse Employee + Child(ren)
Family
Option 3 Choice AQOB
Employee Pays (Weekly)
Employee Only
$ 75.99 $247.65 $180.48 $339.70
Employee + Spouse Employee + Child(ren)
Family
4
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