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
$206.02
$162.65
No Cost
No Cost
Employee + Spouse
$865.29
$683.12
$619.94
$497.49
Employee + Child(ren)
$293.58
$231.77
$210.24
$168.71
Family
$927.09
$731.91
$663.90
$533.75
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MOTHER BENEFITS GUIDE
CONTRIBUTIONS I
20
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