| Bi-Weekly Contributions | Employee Only | Employee + Spouse | Employee + Child(ren) | Employee + Family |
|---|---|---|---|---|
| Traditional HMO | ||||
| Wellness | $204.81 | $524.29 | $471.04 | $737.27 |
| Non-Wellness | $225.29 | $576.72 | $518.14 | $811.00 |
| Deductible HMO | ||||
| Wellness | $118.76 | $335.60 | $263.43 | $478.04 |
| Non-Wellness | $130.64 | $369.16 | $289.78 | $525.84 |
| Tobacco Surcharge | $17.31 added per pay period, per tobacco user | |||