| Coverage Tier | Total Premium/mo | EE Contribution/mo | # Employees |
|---|---|---|---|
| Employee Only | $ |
$ |
|
| EE + Spouse | $ |
$ |
|
| EE + Child(ren) | $ |
$ |
|
| Employee + Family | $ |
$ |
| Employee Only | $340.43 / mo |
| Employee + Spouse | $477.73 / mo |
| Employee + Child(ren) | $446.03 / mo |
| Employee + Family | $614.50 / mo |