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2017 Flexible Benefits Plan Renewal <br /> Single +Spouse +Child(ren) Family <br /> City Contribution 624.00 910.00 910.00 1,223.00 <br /> Medica Choice Passport Network <br /> $500 Ded 80/20 Mthly Premium 603.16 1,320.11 1,308.64 1,993.64 <br /> Monthly Employee Cost -20.84 410.11 398.64 770.64 <br /> Annual Employee Cost -250.08 4,921.32 4,783.68 9,247.68 <br /> $2,600 100% HDHP Passport 517.64 1,132.93 1,123.08 1,710.96 <br /> Monthly Employee Cost -106.36 222.93 213.08 487.96 <br /> Annual Employee Cost -1,276.32 2,675.16 2,556.96 5,855.52 <br /> $2,600 80/20 HDHP Passport 451.24 987.61 979.03 1,491.50 <br /> Monthly Employee Cost -172.76 77.61 69.03 268.50 <br /> Annual Employee Cost -2,073.12 931.32 828.36 3,222.00 <br /> Medica Elect or Essential Network <br /> $2,600 100% HDHP Elect/Essential 481.40 1,053.62 1,044.47 1,591.19 <br /> Monthly Employee Cost -142.60 143.62 134.47 368.19 <br /> Annual Employee Cost -1,711.20 1,723.44 1,613.64 4,418.28 <br /> Additional HSA contribution $480 for the year, $20.00 per pay period. <br /> Opt-Out of Medical 300.00 <br /> Delta Dental 35.48 93.90 93.90 93.90 <br />