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08/01/11-07/31/12

MONTHLY PREMIUM
Medical Plan

Vision

Dental

Plan

Types

Plan 1
Co-Pay Plan

Plan 2
High Deductible
(HDHP)

Vision

 Plan

Dental

Plan

Student

  Under Age 30

  Age 30 & Over


$181

$215


$108
$128

 


$16


$38

Spouse

  Under Age 30

  Age 30 & Over


$366
$441

 


$205
$245

 


$9.30


$32

Child(ren)

 


$271

 


$164

 


$16.50


$43

CREDIT/DEBIT CARD PAYMENT OPTION

Monthly Premiums Will Be Charged To A Credit or Debit Card (Visa or MasterCard)

 

 

  • Complete the Onlinr Enrollment Form
  • Do not send any payment - premium will be charged to your Master Card or VISA Credit or Debit Card
 


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