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2015 Flexible Benefits Plan Renewal <br /> Single +Spouse +Child(ren) Family <br /> City Contribution 562.00 820.00 820.00 1,102.00 <br /> Life Ins 4.50 4.50 4.50 4.50 <br /> Remaining for Health Ins 557.50 815.50 815.50 1097.50 <br /> Medica Choice Passport Network <br /> $25 Co-pay Mthly Premium 636.49 1,393.03 1,380.92 2,103.79 <br /> Monthly Employee Cost 78.99 577.53 565.42 1,006.29 <br /> Annual Employee Cost 947.88 6,930.36 6,785.04 12,075.48 <br /> $500 Ded Mthly Premium 551.10 1,206.16 1,195.69 1,821.60 <br /> Monthly Employee Cost -6.40 390.66 380.19 724.10 <br /> Annual Employee Cost -76.80 4,687.92 4,562.28 8,689.20 <br /> $2,500 HDHP Mthly <br /> Premium 443.83 971.38 962.94 1,466.99 <br /> Monthly Employee Cost -113.67 155.88 147.44 369.49 <br /> Annual Employee Cost -1,364.04 1,870.56 1,769.28 4,433.88 <br /> Medica Elect or Essential Network <br /> $2,500 HDHP Mthly <br /> Premium 412.76 903.39 895.54 1,364.30 <br /> Monthly Employee Cost -144.74 87.89 80.04 266.80 <br /> Annual Employee Cost -1,736.88 1,054.68 960.48 3,201.60 <br /> Additional HSA contribution of$324 for the year, $13.50 per pay period. <br /> Opt-Out of Medical 300.00 <br /> Dental <br /> Single 37.01 <br /> Family 98.75 <br />