Employee Rate Sheet



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BIWEEKLY PREMIUMS Medical/Mental Health PLAN 1 Kaiser Permanente HMO PLAN 2 Anthem Blue Cross HMO PLAN 3 Anthem Blue Cross PPO 250 Prescription Kaiser Permanente US Script/Envolve US Script/Envolve Vision Dental Plans Kaiser Permanente Delta Dental DeltaCare DPPO or USA DHMO Vision Service Plan (VSP) Delta Dental DeltaCare DPPO or USA DHMO Vision Service Plan (VSP) Delta Dental DeltaCare DPPO or USA DHMO Employee Only Employee + Spouse Employee + Child(ren) Employee + Family EMPLOYEE COST 98.64 86.99 291.17 273.99 213.56 201.28 495.56 477.00 EMPLOYEE COST 113.97 102.32 317.88 300.70 237.13 224.85 530.50 511.94 EMPLOYEE COST 210.90 199.25 642.17 624.99 546.06 533.78 1,020.86 1,002.30 Medical/Mental Health PLAN 4 Anthem Blue Cross PPO 1000 PLAN 5 Anthem Blue Cross HDPPO 1500 PLAN 6 Anthem Blue Cross HDPPO 3000 Prescription US Script/Envolve Anthem Blue Cross Anthem Blue Cross Vision Dental Plans Vision Service Plan (VSP) Delta Dental DeltaCare DPPO or USA DHMO Vision Service Plan (VSP) Delta Dental DeltaCare DPPO or USA DHMO Vision Service Plan (VSP) Delta Dental DeltaCare DPPO or USA DHMO EMPLOYEE COST 91.83 80.18 392.22 375.04 319.61 307.33 675.55 656.99 EMPLOYEE COST 59.74 48.09 324.86 307.68 258.58 246.30 582.49 563.93 EMPLOYEE COST 2.84 0.00 210.24 193.06 149.65 137.37 415.93 397.37 Employee Only Employee + Spouse Employee + Child(ren) Employee + Family These rates do not apply to part-time employees who are eligible for health insurance..

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