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Single +Spouse +Child(ren)Family <br />City Contribution 590.00 861.00 861.00 1,157.00 <br />Life Ins 4.50 4.50 4.50 4.50 <br />Single Dental 37.31 37.31 37.31 37.31 <br />Remaining for Health Ins 548.19 819.19 819.19 1115.19 <br />Medica Choice Passport Network <br />$25 Co-pay Mthly Premium 668.31 1,462.68 1,449.97 2,208.98 <br />Monthly Employee Cost 120.12 643.49 630.78 1,093.79 <br />Annual Employee Cost 1,441.44 7,721.88 7,569.36 13,125.48 <br />$500 Ded Mthly Premium 578.66 1,266.47 1,255.47 1,912.68 <br />Monthly Employee Cost 30.47 447.28 436.28 797.49 <br />Annual Employee Cost 365.64 5,367.36 5,235.36 9,569.88 <br />$2,600 HDHP Passport 466.02 1,019.95 1,011.09 1,540.34 <br />Monthly Employee Cost -82.17 200.76 191.90 425.15 <br />Annual Employee Cost -986.04 2,409.12 2,302.80 5,101.80 <br />Medica Elect or Essential Network <br />$2,600 HDHP Elect/Essential 433.40 948.56 940.32 1,432.52 <br />Monthly Employee Cost -114.79 129.37 121.13 317.33 <br />Annual Employee Cost -1,377.48 1,552.44 1,453.56 3,807.96 <br />Additional HSA contribution $480 for the year, $20.00 per pay period. <br />Opt-Out of Medical 300.00 <br />2016 Flexible Benefits Plan Renewal