Employee Cost Four Medical Plan Options Gold Buy-Up PPO Buy-Up PPO Core HDHP Basic HDHP Monthly 24 Deductions 20 Deductions Monthly 24 Deductions 20 Deductions Monthly 24 Deductions 20 Deductions Monthly 24 Deductions 20 Deductions Employee $302.61 $151.31 $181.57 $242.68 $121.34 $145.61 $143.23 $71.62 $85.94 $57.27 $28.64 $34.36 Only Employee + $764.76 $382.38 $458.86 $608.95 $304.48 $365.37 $350.39 $175.20 $210.24 $158.00 $79.00 $94.80 Spouse Employee + $582.81 $291.41 $349.69 $464.73 $232.37 $278.84 $268.83 $134.42 $161.30 $118.35 $59.18 $71.01 Child(ren) Family $839.88 $419.94 $503.93 $668.48 $334.24 $401.09 $384.06 $192.03 $230.44 $174.48 $87.24 $104.69 SEE THE MEDICAL OVERVIEW
Noblesville Schools Employee Benefit Guide Page 4 Page 6