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HEALTH PLANSTIER LEVEL Low PlanHorizon OmniaMid PlanHorizon EE EPOHigh PlanHorizon DE EPOEMPLOYEE $60.00 $150.00 $270.00EMPLOYEE + SPOUSE $170.00 $240.00 $450.00EMPLOYEE + CHILD(REN) $160.00 $230.00 $430.00FAMILY $240.00 $310.00 $650.00BENEFITS COST PER PAYCHECKYour Enrollment Forms and Instructionswill be provided by your HumanResources Department.The contributions listed above are applicable to full time employees, working 30-40 hours per week. Part timeemployees, defined as working 25-29 hours per week, will contribute two times the contribution listed. Forexample, an employee with single coverage working 29 hours a week will contribute $540.00 a pay for the highoption or $ 300.00 for the mid option, and $ 120.00 for the low option.60