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 $5.70 $11.40 Employee + Spouse $12.42 $24.84 Employee + Child(ren) $14.88 $29.76 Family $21.38 $42.76 Premium Employee Only $1.26 Employee + Spouse $2.12 Employee + Child(ren) $2.16 Family $3.43 C O S T O F C O V E R A G E