MEDICAL CONTRIBUTION SCHEDULE
BASE Choice Plus FQ3
Employee Pays (Per Pay Period)
Total Monthly Cost
Employee Only
$0.00 $0.00 $0.00 $0.00
$548.44
Employee + Spouse
$1,173.66 $1,033.92 $1,743.81
Employee + Child(ren)
Family
BUY-UP Choice Plus FXT
Employee Pays (Per Pay Period)
Total Monthly Cost
Employee Only
$29.02 $62.11 $54.72 $92.28
$674.21
Employee + Spouse
$1,442.81 $1,271.02 $2,143.70
Employee + Child(ren)
Family
4
Made with FlippingBook - professional solution for displaying marketing and sales documents online