DENTAL Monthly Premiums VISION MEDICAL Base HDHP Buy-Up Employee Only $152.67 $99.93 $189.27 Employee + Spouse $604.65 $390.84 $742.30 Employee + Child(ren) $549.67 $355.30 $674.83 Family $1,136.01 $740.06 $1,403.14 C O S T O F C O V E R A G E DENTAL Monthly Premiums Base Buy-Up Employee Only $7.59 $9.46 Employee + Spouse $24.65 $30.30 Employee + Child(ren) $25.08 $30.66 Family $50.40 $62.22 Base Buy-Up Employee Only $1.46 $1.80 Employee + Spouse $3.76 $4.62 Employee + Child(ren) $3.84 $4.73 Family $7.73 $9.50