Employee Cost: Dental & Vision Dental Vision Goshen Pays You Pay Goshen Pays You Pay You Pay You Pay (26 Pays) (26 Pays) (20 Pays) (20 Pays) (26 Pays) (20 Pays) Employee $12.78 $4.87 $16.61 $6.33 Employee $2.53 $3.29 ALL ELIGIBLE Employee + $25.85 $7.06 $33.61 $9.18 Employee + $5.06 $6.58 EMPLOYEES Spouse ALL Spouse (Including Employee + EMPLOYEES Employee + 75/80/90/100% Child(ren) $27.92 $7.63 $36.29 $9.92 Child(ren) $5.42 $7.04 Teachers) Goshen Goshen Total Schools Employee Cost Family Pays Family Pays $42.78 $11.69 $55.61 $15.20 $8.65 $11.25 Employee Only Employee $8.82 $8.82 $11.47 $11.47 $9.88 $19.76 $30.00 Employee + $17.88 $15.04 $23.24 $19.55 Employee + Spouse 40/50/90/70% $39.17 $78.34 $59.00 Spouse TEACHER Employee + Employee + Child(ren) $19.31 $16.24 $25.10 $21.12 Child(ren) $28.66 $57.32 $49.00 Family $29.58 $24.88 $38.46 $32.35 Family Employee $53.62 $107.84 $74.00 $10.79 $6.85 $14.03 $8.91 Employee + $22.15 $10.77 $28.80 $13.99 SUPPORT SCHOOL Spouse YEAR / SEC / Employee + BOOKKEEP Child(ren) $23.92 $11.63 $31.10 $15.12 Family $36.65 $17.81 $47.65 $23.16