Page 4 - QCHC.19 Employee Benefits

3+ Children $1074.03 $1074.03 $1074.03 $1074.03 $1074.03 $1074.03 $1074.03 $1074.03 $1074.03 $1074.03

2 Children $631.80 $631.80 $631.80 $631.80 $631.80 $631.80 $631.80 $631.80 $631.80 $631.80

1 Child $315.90 $315.90 $315.90 $315.90 $315.90 $315.90 $315.90 $315.90 $315.90 $315.90

Spouse Male $261.46 $288.68 $348.58 $430.24 $544.58 $702.48 $947.49 $1274.18 $1,649.86 $1,987.44

Employee Female $566.36 $697.04 $751.48 $746.04 $773.26 $882.16 $1072.72 $1285.07 $1,551.85 $1,775.09

Spouse Female $713.37 $762.37 $789.60 $811.38 $773.26 $882.16 $1072.72 $1285.07 $1,551.85 $1,775.09
SuperMed Plus - HSA P3000/6000 Consumer MM Rx, HSAComp

Employee Male $261.46 $288.68 $348.58 $430.24 $544.58 $702.48 $947.49 $1274.18 $1,649.86 $1,987.44

000 TO 024 025 TO 029 030 TO 034 035 TO 039 040 TO 044 045 TO 049 050 TO 054 055 TO 059 060 TO 064 065 TO 105
Age