Total Cost for Health Insurance Premiums

CLASSIC PLAN

FY21 12 Month: 75-100% Appointed

FY21 9 Month: 75-100% Appointed

FY21 12 Month: 50-74% Appointed

FY21 9 Month: 50-74% Appointed

Below $28,000

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	83.72%	$467.07	$76.04	$391.03
Emp & Sp	75.00%	$1,090.77	$272.69	$818.08
Emp & Ch(ren)	77.00%	$873.81	$200.98	$672.83
Emp, Sp & Ch(ren)	76.00%	$1,506.60	$361.58	$1,145.02

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	83.72%	$622.75	$101.39	$521.37
Emp & Sp	42.50%	$2,566.64	$363.59	$1,090.77
Emp & Ch(ren)	77.00%	$1,165.08	$267.97	$897.11
Emp, Sp & Ch(ren)	76.00%	$2,008.80	$482.11	$1,526.69

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	62.79%	$467.07	$173.80	$293.27
Emp & Sp	56.25%	$1,090.77	$477.21	$613.56
Emp & Ch(ren)	57.75%	$873.81	$369.19	$504.62
Emp, Sp & Ch(ren)	57.00%	$1,506.60	$647.84	$858.76

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	62.79%	$622.75	$231.73	$391.02
Emp & Sp	56.25%	$1,454.36	$636.28	$818.08
Emp & Ch(ren)	57.75%	$1,165.08	$492.25	$672.83
Emp, Sp & Ch(ren)	57.00%	$2,008.80	$863.78	$1,145.02

$28,000 - $38,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	83.72%	$467.07	$76.04	$391.03
Emp & Sp	72.00%	$1,090.77	$305.42	$785.35
Emp & Ch(ren)	75.00%	$873.81	$218.45	$655.36
Emp, Sp & Ch(ren)	74.00%	$1,506.60	$391.71	$1,114.89

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	83.72%	$622.75	$101.39	$521.37
Emp & Sp	72.00%	$1,454.36	$407.22	$1,047.14
Emp & Ch(ren)	75.00%	$1,165.08	$291.27	$873.81
Emp, Sp & Ch(ren)	74.00%	$2,008.80	$522.29	$1,486.51

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	62.79%	$467.07	$173.80	$293.27
Emp & Sp	54.00%	$1,090.77	$501.76	$589.01
Emp & Ch(ren)	56.25%	$873.81	$382.29	$491.52
Emp, Sp & Ch(ren)	55.50%	$1,506.60	$670.44	$836.16

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	62.79%	$622.75	$231.73	$391.02
Emp & Sp	54.00%	$1,454.36	$669.00	$785.36
Emp & Ch(ren)	56.25%	$1,165.08	$509.73	$655.35
Emp, Sp & Ch(ren)	55.50%%	$2,008.80	$893.92	$1,114.88

$39,000 - $54,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	82.09%	$467.07	$83.65	$383.42
Emp & Sp	70.00%	$1,090.77	$327.23	$763.54
Emp & Ch(ren)	72.50%	$873.81	$240.30	$633.51
Emp, Sp & Ch(ren)	72.00%	$1,506.60	$421.85	$1,084.75

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	82.09%	$622.75	$111.53	$511.23
Emp & Sp	70.00%	$1,454.36	$436.31	$1,018.05
Emp & Ch(ren)	72.50%	$1,165.08	$320.40	$844.68
Emp, Sp & Ch(ren)	72.00%	$2,008.80	$562.46	$1,446.34

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	61.57%	$467.07	$179.50	$287.57
Emp & Sp	52.50%	$1,090.77	$518.12	$572.65
Emp & Ch(ren)	54.37%	$873.81	$398.68	$475.13
Emp, Sp & Ch(ren)	54.00%	$1,506.60	$693.03	$813.57

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	61.57%	$622.75	$239.33	$383.42
Emp & Sp	52.50%	$1,454.36	$690.82	$763.54
Emp & Ch(ren)	54.37%	$1,165.08	$531.57	$633.51
Emp, Sp & Ch(ren)	54.00%	$2,008.80	$924.05	$1,084.75

$55,000 - $99,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	80.63%	$467.07	$90.48	$376.58
Emp & Sp	68.00%	$1,090.77	$349.05	$741.72
Emp & Ch(ren)	70.00%	$873.81	$262.14	$611.67
Emp, Sp & Ch(ren)	69.00%	$1,506.60	$467.04	$1,039.56

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	80.63%	$622.75	$120.64	$502.12
Emp & Sp	68.00%	$1,454.36	$465.40	$988.96
Emp & Ch(ren)	70.00%	$1,165.08	$349.52	$815.56
Emp, Sp & Ch(ren)	69.00%	$2,008.80	$622.73	$1,386.07

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	60.47%	$467.07	$184.63	$282.44
Emp & Sp	51.00%	$1,090.77	$534.48	$556.29
Emp & Ch(ren)	52.50%	$873.81	$415.06	$458.75
Emp, Sp & Ch(ren)	51.75%	$1,506.60	$726.93	$779.67

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	60.47%	$622.75	$246.17	$376.58
Emp & Sp	51.00%	$1,454.36	$712.63	$741.73
Emp & Ch(ren)	52.50%	$1,165.08	$553.41	$611.67
Emp, Sp & Ch(ren)	51.75%	$2,008.80	$969.25	$1,039.55

$100,000 - $149,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	80.30%	$467.07	$92.01	$375.06
Emp & Sp	66.00%	$1,090.77	$370.86	$719.91
Emp & Ch(ren)	68.00%	$873.81	$279.62	$594.19
Emp, Sp & Ch(ren)	66.50%	$1,506.60	$504.71	$1,001.89

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	80.30%	$622.75	$122.68	$500.08
Emp & Sp	66.00%	$1,454.36	$494.48	$959.88
Emp & Ch(ren)	68.00%	$1,165.08	$372.83	$792.25
Emp, Sp & Ch(ren)	66.50%	$2,008.80	$672.95	$1,335.85

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	60.23%	$467.07	$185.77	$281.30
Emp & Sp	49.50%	$1,090.77	$550.84	$539.93
Emp & Ch(ren)	51.00%	$873.81	$428.17	$445.64
Emp, Sp & Ch(ren)	49.88%	$1,506.60	$755.18	$751.42

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	60.23%	$622.75	$247.69	$375.06
Emp & Sp	49.50%	$1,454.36	$734.45	$719.91
Emp & Ch(ren)	51.00%	$1,165.08	$570.89	$594.19
Emp, Sp & Ch(ren)	49.88%	$2,008.80	$1,006.91	$1,001.89

Above $150,000

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	79.98%	$467.07	$93.52	$373.54
Emp & Sp	63.00%	$1,090.77	$403.59	$687.18
Emp & Ch(ren)	65.00%	$873.81	$305.83	$567.98
Emp, Sp & Ch(ren)	64.00%	$1,506.60	$542.37	$964.23

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	79.98%	$622.75	$124.69	$498.07
Emp & Sp	63.00%	$1,454.36	$538.11	$916.25
Emp & Ch(ren)	65.00%	$1,165.08	$407.78	$757.30
Emp, Sp & Ch(ren)	64.00%	$2,008.80	$723.17	$1,285.63

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	59.98%	$467.07	$186.02	$280.15
Emp & Sp	47.25%	$1,090.77	$575.38	$515.39
Emp & Ch(ren)	48.75%	$873.81	$447.83	$425.98
Emp, Sp & Ch(ren)	48.00%	$1,506.60	$783.43	$723.17

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	59.98%	$622.75	$249.21	$373.54
Emp & Sp	47.25%	$1,454.36	$767.17	$687.19
Emp & Ch(ren)	48.75%	$1,165.08	$597.10	$567.98
Emp, Sp & Ch(ren)	48.00%	$2,008.80	$1,044.58	$964.22

HEALTH SAVINGS PLAN

FY21 12 Month: 75-100% Appointed

FY21 9 Month: 75-100% Appointed

FY21 12 Month: 50-74% Appointed

FY21 9 Month: 50-74% Appointed

Below $28,000

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	96.44%	$405.45	$14.42	$391.03
Emp & Sp	88.66%	$922.73	$104.65	$818.08
Emp & Ch(ren)	88.53%	$759.98	$87.15	$672.83
Emp, Sp & Ch(ren)	88.93%	$1,287.54	$142.52	$1,145.02

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	96.44%	$540.60	$19.23	$521.37
Emp & Sp	88.66%	$1,230.30	$139.53	$1,090.77
Emp & Ch(ren)	88.53%	$1,013.30	$116.20	$897.11
Emp, Sp & Ch(ren)	88.93%	$1,716.72	$190.03	$1,526.69

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	72.33%	$405.45	$112.18	$293.27
Emp & Sp	66.49%	$922.73	$309.17	$613.56
Emp & Ch(ren)	66.40%	$459.98	$255.36	$504.62
Emp, Sp & Ch(ren)	66.70%	$1,287.54	$1,287.54	$858.77

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	72.33%	$540.60	$179.57	$391.03
Emp & Sp	66.49%	$1,230.30	$412.22	$818.08
Emp & Ch(ren)	66.40%	$1,013.30	$340.48	$672.82
Emp, Sp & Ch(ren)	66.70%	$1,716.72	$571.71	$1,145.01

$28,000 - $38,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	96.44%	$405.45	$14.42	$391.03
Emp & Sp	85.11%	$922.73	$137.38	$785.35
Emp & Ch(ren)	86.23%	$759.98	$104.62	$655.36
Emp, Sp & Ch(ren)	86.59%	$1,287.54	$172.65	$1,114.89

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	96.44%	$540.60	$19.23	$521.37
Emp & Sp	85.11%	$1,230.30	$183.17	$1,047.14
Emp & Ch(ren)	86.24%	$1,013.30	$139.49	$873.82
Emp, Sp & Ch(ren)	86.59%	$1,716.72	$230.20	$1,486.52

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	72.33%	$405.45	$112.18	$293.27
Emp & Sp	63.83%	$922.73	$333.72	$589.01
Emp & Ch(ren)	64.68%	$759.98	$268.46	$491.52
Emp, Sp & Ch(ren)	64.94%	$1,287.54	$451.37	$836.17

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	72.33%	$540.60	$149.57	$391.03
Emp & Sp	63.83%	$1,230.30	$444.95	$785.35
Emp & Ch(ren)	64.68%	$1,013.30	$357.94	$655.35
Emp, Sp & Ch(ren)	64.94%	$1,716.72	$601.84	$1,114.88

$39,000 - $54,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	94.57%	$405.45	$22.03	$383.42
Emp & Sp	82.75%	$922.73	$159.19	$763.54
Emp & Ch(ren)	83.36%	$759.98	$126.47	$633.51
Emp, Sp & Ch(ren)	84.25%	$1,287.54	$202.79	$1,084.75

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	94.57%	$540.60	$29.37	$511.23
Emp & Sp	82.75%	$1,230.30	$212.25	$1,018.06
Emp & Ch(ren)	83.36%	$1,013.30	$168.63	$844.67
Emp, Sp & Ch(ren)	84.25%	$1,716.72	$270.39	$1,446.33

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	70.93%	$405.45	$117.88	$287.57
Emp & Sp	62.06%	$922.73	$350.07	$572.66
Emp & Ch(ren)	62.52%	$759.98	$284.85	$475.13
Emp, Sp & Ch(ren)	63.19%	$1,287.54	$473.98	$813.57

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	70.92%	$540.60	$157.18	$383.42
Emp & Sp	62.06%	$1,230.30	$466.76	$763.54
Emp & Ch(ren)	62.52%	$1,013.30	$379.79	$633.51
Emp, Sp & Ch(ren)	63.19%	$1,716.72	$631.97	$1,084.75

$55,000 - $99,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	92.88%	$405.45	$28.87	$376.58
Emp & Sp	80.38%	$922.73	$181.01	$741.72
Emp & Ch(ren)	80.49%	$759.98	$148.31	$611.67
Emp, Sp & Ch(ren)	80.74%	$1,287.54	$247.98	$1,039.56

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	92.88%	$540.60	$38.49	$502.11
Emp & Sp	80.38%	$1,230.30	$241.35	$988.96
Emp & Ch(ren)	80.48%	$1,013.30	$197.75	$815.55
Emp, Sp & Ch(ren)	80.74%	$1,716.72	$330.64	$1,386.08

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	69.66%	$405.45	$123.01	$282.44
Emp & Sp	60.29%	$922.73	$366.44	$556.29
Emp & Ch(ren)	60.36%	$459.98	$301.23	$458.75
Emp, Sp & Ch(ren)	60.55%	$1,287.54	$507.87	$779.67

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	69.66%	$540.60	$164.02	$376.58
Emp & Sp	60.29%	$1,230.30	$488.58	$741.72
Emp & Ch(ren)	60.36%	$1,013.30	$401.63	$611.67
Emp, Sp & Ch(ren)	60.55%	$1,716.72	$677.17	$1,039.55

$100,000 - $149,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	92.50%	$405.45	$30.39	$375.06
Emp & Sp	78.02%	$922.73	$202.82	$719.91
Emp & Ch(ren)	78.19%	$759.98	$165.79	$594.19
Emp, Sp & Ch(ren)	77.81%	$1,287.54	$285.65	$1,001.89

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	92.50%	$540.60	$40.52	$500.08
Emp & Sp	78.02%	$1,230.30	$270.42	$959.89
Emp & Ch(ren)	78.19%	$1,013.30	$221.05	$792.26
Emp, Sp & Ch(ren)	77.81%	$1,716.72	$380.87	$1,335.85

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	69.38%	$405.45	$124.15	$281.30
Emp & Sp	58.51%	$922.73	$382.80	$539.93
Emp & Ch(ren)	58.64%	$759.98	$314.34	$445.64
Emp, Sp & Ch(ren)	58.36%	$1,287.54	$536.12	$751.42

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	69.38%	$540.60	$165.54	$375.06
Emp & Sp	58.52%	$1,230.30	$510.39	$719.91
Emp & Ch(ren)	58.64%	$1,013.30	$419.11	$594.19
Emp, Sp & Ch(ren)	58.36%	$1,716.72	$714.83	$1,001.89

Above $150,000

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	92.13%	$405.45	$31.91	$373.54
Emp & Sp	74.47%	$922.73	$235.55	$687.18
Emp & Ch(ren)	74.74%	$759.98	$192.00	$567.98
Emp, Sp & Ch(ren)	74.89%	$1,287.54	$323.31	$964.23

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	92.13%	$540.60	$42.55	$498.05
Emp & Sp	74.47%	$1,230.30	$314.06	$916.24
Emp & Ch(ren)	74.74%	$1,013.30	$256.00	$757.30
Emp, Sp & Ch(ren)	74.89%	$1,716.72	$431.08	$1,285.64

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	69.10%	$405.45	$125.29	$280.16
Emp & Sp	55.86%	$922.73	$407.34	$515.39
Emp & Ch(ren)	56.05%	$759.98	$333.99	$425.99
Emp, Sp & Ch(ren)	56.17%	$1,287.54	$564.37	$723.17

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	69.10%	$540.60	$167.06	$373.54
Emp & Sp	55.85%	$1,230.30	$543.12	$687.18
Emp & Ch(ren)	56.05%	$1,013.30	$445.32	$567.98
Emp, Sp & Ch(ren)	56.17%	$1,716.72	$752.50	$964.22

PREMIER PLAN

FY21 12 Month: 75-100% Appointed

FY21 9 Month: 75-100% Appointed

FY21 12 Month: 50-74% Appointed

FY21 9 Month: 50-74% Appointed

Below $28,000

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	68.07%	$599.54	$191.45	$408.09
Emp & Sp	56.16%	$1,365.68	$598.75	$766.93
Emp & Ch(ren)	57.88%	$1,119.51	$471.55	$647.96
Emp, Sp & Ch(ren)	57.19%	$1,883.80	$806.50	$1,077.30

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	68.07%	$799.39	$255.26	544.12
Emp & Sp	56.16%	$1,820.91	$798.33	$1,022.58
Emp & Ch(ren)	57.88%	$1,492.68	$628.74	$863.94
Emp, Sp & Ch(ren)	57.19%	$2,511.73	$1,075.34	$1,436.40

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	51.05%	$599.54	$293.48	$306.06
Emp & Sp	42.12%	$1,365.68	$790.48	$575.20
Emp & Ch(ren)	43.41%	$1,119.51	$633.54	$485.97
Emp, Sp & Ch(ren)	42.89%	$1,883.80	$1,075.83	$807.97

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	51.05%	$799.39	$391.30	$408.08
Emp & Sp	42.12%	$1,820.91	$1,053.98	$766.93
Emp & Ch(ren)	43.41%	$1,492.68	$844.73	$647.95
Emp, Sp & Ch(ren)	42.89	$2,511.73	$1,434.44	$1,077.30

$28,000 - $38,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	68.07%	$599.54	$191.45	$408.09
Emp & Sp	53.91%	$1,365.68	$629.43	$736.25
Emp & Ch(ren)	56.38%	$1,119.51	$488.38	$631.13
Emp, Sp & Ch(ren)	55.68%	$1,883.80	$834.86	$1,048.94

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	68.07%	$799.39	$255.26	$544.12
Emp & Sp	53.91%	$1,820.91	$839.23	$981.67
Emp & Ch(ren)	56.38%	$1,492.68	$651.17	$841.51
Emp, Sp & Ch(ren)	55.68%	$2,511.73	$1,113.14	$1,398.59

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	51.05%	$599.54	$293.48	$306.06
Emp & Sp	40.43%	$1,365.68	$813.49	$552.19
Emp & Ch(ren)	42.28%	$1,119.51	$646.16	$473.35
Emp, Sp & Ch(ren)	41.76%	$1,883.80	$1,097.09	$786.71

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	51.05%	$799.39	$391.30	$408.09
Emp & Sp	40.43%	$1,820.91	$1,084.66	$736.25
Emp & Ch(ren)	42.28%	$1,492.68	$861.56	$631.12
Emp, Sp & Ch(ren)	41.76%	$2,511.73	$1,462.79	$1,048.94

$39,000 - $54,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	66.71%	$599.54	$199.61	$399.93
Emp & Sp	52.41%	$1,365.68	$649.88	$715.80
Emp & Ch(ren)	54.50%	$1,119.51	$509.43	$610.08
Emp, Sp & Ch(ren)	54.18%	$1,883.80	$863.21	$1,020.59

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	66.71%	$799.39	$266.15	533.24
Emp & Sp	52.41%	$1820.91	$866.51	$954.39
Emp & Ch(ren)	54.50%	$1,492.68	$679.24	$813.44
Emp, Sp & Ch(ren)	54.18%	$2,511.73	$1,150.95	$1,360.79

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	50.03%	$599.54	$299.59	$299.95
Emp & Sp	39.31%	$1,365.68	$828.83	$536.85
Emp & Ch(ren)	40.87%	$1,119.51	$661.95	$457.56
Emp, Sp & Ch(ren)	40.63%	$1,883.80	$1,118.36	$765.44

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	50.03%	$799.39	$399.46	$399.93
Emp & Sp	39.31%	$1,820.91	$1,105.11	$715.80
Emp & Ch(ren)	40.87%	$1,492.68	$882.60	$610.08
Emp, Sp & Ch(ren)	40.63%	$2,511.73	$1,491.15	$1,020.59

$55,000 - $99,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	65.37%	$599.54	$207.61	$391.93
Emp & Sp	50.92%	$1,365.68	$670.33	$695.35
Emp & Ch(ren)	52.62%	$1,119.51	$530.46	$589.05
Emp, Sp & Ch(ren)	51.92%	$1,883.80	$905.73	$978.07

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	65.37%	$799.39	$276.81	$522.58
Emp & Sp	50.92%	$1,820.91	$893.78	$927.13
Emp & Ch(ren)	52.62%	$1,492.68	$707.29	$785.39
Emp, Sp & Ch(ren)	51.92%	$2,511.73	$1,207.63	$1,304.10

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	49.03%	$599.54	$305.59	$293.95
Emp & Sp	38.19%	$1,365.68	$844.17	$521.51
Emp & Ch(ren)	39.46%	$1,119.51	$677.72	$441.79
Emp, Sp & Ch(ren)	38.94%	$1,883.80	$1,150.24	$733.56

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	49.03%	$799.39	$407.46	$391.93
Emp & Sp	38.19%	$1,820.91	$1,125.56	$695.34
Emp & Ch(ren)	39.46%	$1,492.68	$903.64	$589.04
Emp, Sp & Ch(ren)	38.94%	$2,511.73	$1,533.66	$978.07

$100,000 - $149,999

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	64.06%	$599.54	$215.45	$384.09
Emp & Sp	49.42%	$1,365.68	$690.79	$674.89
Emp & Ch(ren)	51.11%	$1,119.51	$547.29	$572.22
Emp, Sp & Ch(ren)	50.04%	$1,883.80	$941.17	$942.63

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	64.06%	$799.39	287.26	$512.11
Emp & Sp	49.42%	$1,820.91	$921.05	$899.86
Emp & Ch(ren)	51.11%	$1,492.68	$729.72	$762.96
Emp, Sp & Ch(ren)	50.04%	$2,511.73	$1,254.89	$1,256.84

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	48.05%	$599.54	$311.48	$288.06
Emp & Sp	37.06%	$1,365.68	$859.51	$506.17
Emp & Ch(ren)	38.34%	$1,119.51	$690.34	$429.17
Emp, Sp & Ch(ren)	37.53%	$1,883.80	$1,176.83	$706.97

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	48.05%	$799.39	$415.30	$384.09
Emp & Sp	37.06%	$1,820.91	$1,146.02	$674.89
Emp & Ch(ren)	38.33%	$1,492.68	$920.47	$572.21
Emp, Sp & Ch(ren)	37.53%	$2,511.73	$1,569.11	$942.63

Above $150,000

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	62.78%	$599.54	$223.14	$376.40
Emp & Sp	47.17%	$1,365.68	$721.46	$644.22
Emp & Ch(ren)	48.86%	$1,119.51	$572.53	$546.98
Emp, Sp & Ch(ren)	48.16%	$1,883.80	$976.61	$907.19

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	62.78%	$799.39	$297.52	$501.87
Emp & Sp	47.17%	$1,820.91	$961.94	$858.96
Emp & Ch(ren)	48.86%	$1,492.68	$763.38	$729.30
Emp, Sp & Ch(ren)	48.16%	$2,511.73	$1,302.14	$1,209.60

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	47.09%	$599.54	$317.24	$282.30
Emp & Sp	35.38%	$1,365.68	$882.51	$483.17
Emp & Ch(ren)	36.64%	$1,119.51	$709.28	$410.23
Emp, Sp & Ch(ren)	36.12%	$1,883.80	$1,203.41	$680.39

	1/1/2021 Employer %	1/1/2021 TOTAL PREMIUM	*1/1/2021 Employee**	*1/1/2021 Employer**
Employee Only	47.09%	$799.39	$422.98	$376.40
Emp & Sp	35.38%	$1,820.91	$1,176.69	$644.22
Emp & Ch(ren)	36.64%	$1,492.68	$945.71	$546.97
Emp, Sp & Ch(ren)	36.12%	$2,511.73	$1,604.54	$907.19

* Note: Premiums listed for 1/1/2021 may be subject to change, and the total premium for 1/1/2021 is not yet available.