COST OF COVERAGE Monthly Premiums Monthly Premiums Monthly Premiums MEDICAL VISION DENTAL Co-Pay HDHP Premium Employee Only $106.91 $0.00 Premium Employee Only $0.00 Employee + Employee Only $0.00 Spouse $825.00 $245.00 Employee + $9.12 Employee + $1.80 Spouse Spouse Employee + $426.41 $201.00 Employee + Employee + $15.52 Child(ren) Child(ren) $2.15 Child(ren) Family $27.52 Family $973.05 $457.00 Family $4.40