Employee Cost: Medical Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 Goshen Schools Pays Goshen Employee Pays Total Cost Employee Only $9.88 $19.76 $30.00 Employee + Spouse $39.17 $78.34 $59.00 Employee + Child(ren) $28.66 $57.32 $49.00 Family $53.62 $107.84 $74.00 PPO PLAN A PPO PLAN B HDHP C HDHP D Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) Goshen Pays (26 Pays) You Pay (26 Pays) Goshen Pays (20 Pays) You Pay (20 Pays) ALL ELIGIBLE EMPLOYEES (Including 75/80/90/100% Teachers) Employee $207.84 $125.26 $207.16 $100.16 $207.30 $105.48 $206.44 $74.08 Employee + Spouse $457.73 $275.09 $456.22 $219.87 $456.54 $231.58 $454.66 $162.49 Employee + Child(ren) $372.86 $226.72 $371.63 $181.54 $371.89 $191.12 $370.35 $134.58 Family $657.08 $342.22 $655.02 $266.92 $655.46 $282.89 $652.89 $188.67 40/50/60/70% TEACHER Employee $148.14 $184.96 $147.46 $159.86 $147.60 $165.18 $146.74 $133.77 Employee + Spouse $326.24 $406.57 $324.74 $351.36 $325.06 $363.06 $323.17 $293.97 Employee + Child(ren) $265.78 $333.80 $264.54 $288.62 $264.81 $298.20 $263.26 $241.67 Family $467.91 $531.38 $465.86 $456.09 $466.29 $472.06 $463.72 $377.84 SUPPORT SCHOOL YEAR / SEC / BOOKKEEP Employee $270.19 $162.83 $269.30 $130.21 $309.37 $97.24 $308.26 $56.42 Employee + Spouse $595.04 $357.62 $593.09 $285.84 $593.50 $301.06 $591.05 $211.23 Employee + Child(ren) $484.72 $294.73 $483.12 $236.00 $483.46 $248.46 $481.45 $174.96 Family $854.20 $444.89 $851.53 $347.00 $852.10 $367.76 $848.76 $245.27 GOSHEN EMPLOYEE MARRIED TO GOSHEN EMPLOYEE Employee $319.25 $13.85 $415.03 $18.00 $298.08 $9.23 $387.51 $12.00 $308.16 $4.62 $400.61 $6.00 $280.06 $0.46 $364.07 $0.60 Employee + Spouse $718.97 $13.85 $934.66 $18.00 $666.86 $9.23 $866.92 $12.00 $683.51 $4.62 $888.56 $6.00 $616.68 $0.46 $801.68 $0.60 Employee + Child(ren) $585.73 $13.85 $761.45 $18.00 $543.93 $9.23 $707.11 $12.00 $558.40 $4.62 $725.92 $6.00 $504.47 $0.46 $655.81 $0.60 Family $985.45 $13.85 $1,281.08 $18.00 $912.71 $9.23 $1,186.52 $12.00 $933.73 $4.62 $1,213.85 $6.00 $841.10 $0.46 $1,093.43 $0.60