Employee Weekly Cost: Medical CDHP #2 SEE THIS PLAN CDHP #1 SEE THIS PLAN Non-Tobacco Tobacco User Wellness Participant Non- Wellness Wellness Participant Non- Wellness Employee Only $30.00 $60.00 $55.00 $85.00 *Employee + Spouse $86.67 $116.67 $111.67 $141.67 Employee + Child(ren) $76.67 $106.67 $101.67 $131.67 *Family $103.33 $133.33 $128.33 $158.33 Traditional PPO SEE THIS PLAN Non-Tobacco Tobacco User Wellness Participant Non- Wellness Wellness Participant Non- Wellness Employee Only $12.05 $42.05 $37.05 $67.05 *Employee + Spouse $44.11 $74.11 $69.11 $99.11 Employee + Child(ren) $41.12 $71.12 $66.12 $96.12 *Family $52.69 $82.69 $77.69 $107.69 Non-Tobacco Tobacco User Wellness Participant Non- Wellness Wellness Participant Non- Wellness Employee Only $55.00 $85.00 $80.00 $110.00 *Employee + Spouse $140.00 $170.00 $165.00 $195.00 Employee + Child(ren) $125.00 $155.00 $150.00 $180.00 *Family $165.00 $195.00 $190.00 $220.00 *There is an additional surcharge of $25 per pay when you elect coverage for your spouse under the Online Transport plan, if they are also available for benefit coverage through their own employer.