Dental and Vision Plan Costs
DHMO PLAN
| Coverage Tier | Employer | Employee |
|---|---|---|
| Employee Only | $8.26 | $8.26 |
| Employee + Spouse | $16.52 | $16.52 |
| Employee + Child(ren) | $18.27 | $18.27 |
| Employee + Family | $27.16 | $27.16 |
BASIC DPPO PLAN
| Coverage Tier | Employer | Employee |
|---|---|---|
| Employee Only | $13.89 | $13.89 |
| Employee + Spouse | $26.29 | $26.29 |
| Employee + Child(ren) | $28.15 | $28.14 |
| Employee + Family | $41.82 | $41.81 |
ENHANCED DPPO PLAN
| Coverage Tier | Employer | Employee |
|---|---|---|
| Employee Only | $22.54 | $22.53 |
| Employee + Spouse | $43.40 | $43.40 |
| Employee + Child(ren) | $49.67 | $49.68 |
| Employee + Family | $72.71 | $72.72 |
VISION PLAN
| Coverage Tier | Employer | Employee |
|---|---|---|
| Employee Only | $0.00 | $12.20 |
| Employee + Spouse | $0.00 | $19.51 |
| Employee + Child(ren) | $0.00 | $19.92 |
| Employee + Family | $0.00 | $32.10 |
