| Member Only |
Member |
Spouse |
Children |
Monthly Cost |
| 10,000 |
0 |
0 |
3.66 |
| 110,000 |
0 |
0 |
10.66 |
| 160,000 |
0 |
0 |
13.66 |
| 260,000 |
0 |
0 |
19.66 |
| Member & Children |
Member |
Spouse |
Children |
Monthly Cost |
| 10,000 |
0 |
5,000 |
6.99 |
| 110,000 |
0 |
5,000 |
13.99 |
| 160,000 |
0 |
5,000 |
16.99 |
| 260,000 |
0 |
5,000 |
22.99 |
| Member & Spouse |
Member |
Spouse |
Children |
Monthly Cost |
| 10,000 |
5,000 |
0 |
5.66 |
| 10,000 |
105,000 |
0 |
12.66 |
| 110,000 |
5,000 |
0 |
12.66 |
| 110,000 |
105,000 |
0 |
19.66 |
| 160,000 |
5,000 |
0 |
15.66 |
| 160,000 |
105,000 |
0 |
22.66 |
| 160,000 |
155,000 |
0 |
25.66 |
| 260,000 |
5,000 |
0 |
21.66 |
| 260,000 |
105,000 |
0 |
28.66 |
| 260,000 |
155,000 |
0 |
31.66 |
| Member & Family |
Member |
Spouse |
Children |
Monthly Cost |
| 10,000 |
5,000 |
5,000 |
6.99 |
| 10,000 |
105,000 |
5,000 |
13.99 |
| 10,000 |
155,000 |
5,000 |
16.99 |
| 110,000 |
5,000 |
5,000 |
13.99 |
| 110,000 |
105,000 |
5,000 |
20.99 |
| 110,000 |
155,000 |
5,000 |
23.99 |
| 160,000 |
5,000 |
5,000 |
16.99 |
| 160,000 |
105,000 |
5,000 |
23.99 |
| 160,000 |
155,000 |
5,000 |
26.99 |
| 260,000 |
5,000 |
5,000 |
22.99 |
| 260,000 |
105,000 |
5,000 |
29.99 |
| 260,000 |
155,000 |
5,000 |
32.99 |
*Current Monthly Cost for Non-Tobacco Users*
