MEDICAL COSTS

Per Pay Period


Tier
HSA
HSA Tobacco User
HRA
HRA Tobacco User
PPO
PPO Tobacco User
Employee Only
$92.01
$119.65
$163.78
$213.00
$232.30
$302.11
Employee + Spouse
$192.98
$250.97
$345.68
$449.57
$488.40
$635.17
Employee + Children
$176.68
$229.78
$312.60
$407.03
$443.13
$576.28
Employee + Family
$265.70
$345.54
$494.49
$643.10
$715.67

$930.74

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