| Coverage Tier | Total Premium/mo | EE Contribution/mo | # Employees |
|---|---|---|---|
| Employee Only | $ |
$ |
|
| EE + Spouse | $ |
$ |
|
| EE + Child(ren) | $ |
$ |
|
| Employee + Family | $ |
$ |
| Employee Only | $343.20 / mo |
| Employee + Spouse | $483.24 / mo |
| Employee + Child(ren) | $450.91 / mo |
| Employee + Family | $622.75 / mo |