DENTAL Weekly Premium VISION Weekly Premium MEDICAL Weekly Premium Co-Pay HDHP Employee Only $46.62 $16.62 Employee + Spouse $149.77 $102.92 Employee + Child(ren) $93.46 $72.46 Family $167.08 $119.31 $1000 Plan $2000 Plan Employee Only $2.85 $5.70 Employee + Spouse $6.21 $12.42 Employee + Child(ren) $7.44 $14.88 Family $10.69 $21.38 Premium Employee Only $0.63 Employee + Spouse $1.06 Employee + Child(ren) $1.08 Family $1.71 C O S T O F C O V E R A G E