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| BASE PLAN - OAK Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $1927.28 | $1927.28 | $0 |
| Medical and Dental | $1906.92 | $1906.92 | $0 |
| Medical and Vision | $1814.71 | $1814.71 | $0 |
| Medical only | $1794.35 | $1794.35 | $0 |
| REDWOOD Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $2006.7 | $1927.28 | $79.42 |
| Medical and Dental | $1986.34 | $1927.28 | $59.06 |
| Medical and Vision | $1894.13 | $1894.13 | $0 |
| Medical only | $1873.77 | $1873.77 | $0 |
| SPRUCE Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $1785.25 | $1785.25 | $0 |
| Medical and Dental | $1764.89 | $1764.89 | $0 |
| Medical and Vision | $1672.68 | $1672.68 | $0 |
| Medical only | $1652.32 | $1652.32 | $0 |
| PINE Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $1685.25 | $1685.25 | $0 |
| Medical and Dental | $1664.89 | $1664.89 | $0 |
| Medical and Vision | $1572.68 | $1572.68 | $0 |
| Medical only | $1552.32 | $1552.32 | $0 |
| MAPLE SINGLE Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $744.38 | $744.38 | $0 |
| Medical and Dental | $724.02 | $724.02 | $0 |
| Medical and Vision | $631.81 | $631.81 | $0 |
| Medical only | $611.45 | $611.45 | $0 |
| MAPLE 2 PARTY Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $1355.38 | $1355.38 | $0 |
| Medical and Dental | $1335.02 | $1335.02 | $0 |
| Medical and Vision | $1242.81 | $1242.81 | $0 |
| Medical only | $1222.45 | $1222.45 | $0 |
| MAPLE FAMILY Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $1844.35 | $1844.35 | $0 |
| Medical and Dental | $1823.99 | $1823.99 | $0 |
| Medical and Vision | $1731.78 | $1731.78 | $0 |
| Medical only | $1711.42 | $1711.42 | $0 |
| SEQUOIA SINGLE Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $879.51 | $879.51 | $0 |
| Medical and Dental | $859.15 | $859.15 | $0 |
| Medical and Vision | $766.94 | $766.94 | $0 |
| Medical only | $746.58 | $746.58 | $0 |
| SEQUOIA 2 PARTY Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $1625.54 | $1625.54 | $0 |
| Medical and Dental | $1605.18 | $1605.18 | $0 |
| Medical and Vision | $1512.97 | $1512.97 | $0 |
| Medical only | $1492.61 | $1492.61 | $0 |
| SEQUOIA FAMILY Monthly premiums | |||
|---|---|---|---|
| Benefit Choice | Total Premium | Employer Share | Employee Share |
| Medical, Dental and Vision | $2222.57 | $1927.28 | $295.29 |
| Medical and Dental | $2202.21 | $1927.28 | $274.93 |
| Medical and Vision | $2110 | $1927.28 | $182.72 |
| Medical only | $2089.64 | $1927.28 | $162.36 |