Employee Cost MEDICAL Coverage through UMR PPO PLAN HSA PLAN ONE HSA PLAN TWO 26 Pays 20 Pays 26 Pays 20 Pays 26 Pays 20 Pays Employee Only $89.05 $115.76 $62.45 $81.19 $39.18 $50.93 Employee + Spouse $250.00 $325.00 $184.91 $240.39 $92.55 $120.31 Employee + Child(ren) $214.28 $278.57 $158.36 $205.86 $79.32 $103.12 Family $384.83 $500.28 $292.04 $379.65 $132.21 $171.87 26 Pays – Certified Staff and year-round employees