Medical Plan Costs
BASIC HDHP PLAN
NARROW NETWORK
| Coverage Tier | <$50,000 Base Salary | >$50,000 Base Salary |
|---|---|---|
| Employee Only | $0.00 | $20.00 |
| Employee + Spouse | $52.02 | $102.02 |
| Employee + Child(ren) | $0.00 | $50.00 |
| Employee + Family | $134.42 | $209.42 |
BASIC HDHP PLAN
BROAD NETWORK
| Coverage Tier | <$50,000 Base Salary | >$50,000 Base Salary |
|---|---|---|
| Employee Only | $32.11 | $52.11 |
| Employee + Spouse | $119.44 | $169.44 |
| Employee + Child(ren) | $57.79 | $107.79 |
| Employee + Family | $234.27 | $309.27 |
ENHANCED HDHP PLAN
NARROW NETWORK
| Coverage Tier | <$50,000 Base Salary | >$50,000 Base Salary |
|---|---|---|
| Employee Only | $59.05 | $79.05 |
| Employee + Spouse | $177.07 | $227.07 |
| Employee + Child(ren) | $106.29 | $156.29 |
| Employee + Family | $320.76 | $395.76 |
ENHANCED HDHP PLAN
BROAD NETWORK
| Coverage Tier | <$50,000 Base Salary | >$50,000 Base Salary |
|---|---|---|
| Employee Only | $101.18 | $121.18 |
| Employee + Spouse | $265.53 | $315.53 |
| Employee + Child(ren) | $182.12 | $232.12 |
| Employee + Family | $451.77 | $526.77 |
PREMIUM PPO PLAN
BROAD NETWORK ONLY
| Coverage Tier | <$50,000 Base Salary | >$50,000 Base Salary |
|---|---|---|
| Employee Only | $300.57 | $320.57 |
| Employee + Spouse | $690.96 | $740.96 |
| Employee + Child(ren) | $539.63 | $589.63 |
| Employee + Family | $1,025.33 | $1,100.33 |
