Page 11 - Corporate Dining Concepts BCBC Benefits Guide V2

Blue Cross Blue Shield Major Medical Plan + GAP Rates

BCBS Silver $4,000 BCBS $6,350 HDHP

With $1,000 With $4,000 With $1,000 With $4,000
48 Pays 48 Pays
GAP GAP GAP GAP

EE Only $90.16 $104.92 EE Only $41.32 $50.28

EE + Spouse $144.84 $173.51 EE + Spouse $116.98 $145.65

EE + Child $142.33 $166.76 EE + Child $114.47 $138.90

EE + EE +
$173.32 $197.75 $138.49 $162.92
Children Children

Family $180.90 $218.20 Family $146.07 $183.37

11