| Coverage Tier | Total Premium/mo | EE Contribution/mo | # Employees |
|---|---|---|---|
| Employee Only | $ |
$ |
|
| EE + Spouse | $ |
$ |
|
| EE + Child(ren) | $ |
$ |
|
| Employee + Family | $ |
$ |
| Employee Only (Single) | $426.53 / mo $5,118.36 / yr |
| Employee + Spouse | $566.57 / mo $6,798.84 / yr |
| Employee + Child(ren) | $534.44 / mo $6,413.28 / yr |
| Employee + Family | $706.08 / mo $8,472.96 / yr |