Benefit Plan                             Per Pay

MEDICAL/RX AFA CPOSII 2750 HSA

Employee

$88.145

Employee + Spouse

$191.21

Employee + Child(ren)

$172.63

Family

$289.21

MEDICAL/RX IHFA OPEN POSII 2750 HSA

Employee

$72.64

Employee + Spouse

$155.80

Employee + Child(ren)

$140.81

Family

$234.88

DENTAL RATES

Employee

$7.53

Employee + Spouse

$14.38

Employee + Child(ren)

$18.13

Family

$24.98

VISION RATES

Employee

$1.11

Employee + Spouse

$2.55

Employee + Child(ren)

$2.83

Family

$4.32