2025 Monthly Medical/Rx Premiums NOTE: EE Share = Premiums paid by Retiree ER Share = Premiums paid by DePauw CDHP 1 Hired Before 2005 Hired 2005 – 2012 Hired 1/1/2013+ EE Share $92.66 $858.91 Retiree Only ER Share $766.25 - Not Eligible Total $858.91 $858.91 EE Share $212.57 $1,803.75 Retiree + Spouse ER Share $1,591.18 - Not Eligible Total $1,803.75 $1,803.75 EE Share $198.57 $1,590.06 Retiree + Child/ren ER Share $1,391.49 - Not Eligible Total $1,590.06 $1,590.06 EE Share $328.56 $2,662.68 Retiree + Spouse & 1 Child ER Share $2,334.12 - Not Eligible Total $2,662.68 $2,662.68 EE Share $453.73 $2,662.68 Retiree + Spouse & >1 Child ER Share $2,208.95 - Not Eligible Total $2,662.68 $2,662.68 CDHP 2 Hired Before 2005 Hired 2005 – 2012 Hired 1/1/2013+ EE Share $103.47 $865.46 Retiree Only ER Share $761.99 - Not Eligible Total $865.46 $865.46 EE Share $235.28 $1,817.51 Retiree + Spouse ER Share $1,582.23 - Not Eligible Total $1,817.51 $1,817.51 EE Share $218.59 $1,602.18 Retiree + Child/ren ER Share $1,383.59 - Not Eligible Total $1,602.18 $1,602.18 EE Share $362.09 $2,683.00 Retiree + Spouse & 1 Child ER Share $2,320.91 - Not Eligible Total $2,683.00 $2,683.00 EE Share $487.25 $2,683.00 Retiree + Spouse & >1 Child ER Share $2,195.75 - Not Eligible Total $2,683.00 $2,683.00 CDHP 3 Hired Before 2005 Hired 2005 – 2012 Hired 1/1/2013+ EE Share $168.82 $898.34 Retiree Only ER Share $729.52 - Not Eligible Total $898.34 $898.34 EE Share $415.74 $1,886.54 Retiree + Spouse ER Share $1,470.80 - Not Eligible Total $1,886.54 $1,886.54 EE Share $363.35 $1,663.03 Retiree + Child/ren ER Share $1,299.68 - Not Eligible Total $1,663.03 $1,663.03 EE Share $618.96 $2,784.88 Retiree + Spouse & 1 Child ER Share $2,165.92 - Not Eligible Total $2,784.88 $2,784.88 EE Share $744.13 $2,784.88 Retiree + Spouse & >1 Child ER Share $2,040.75 - Not Eligible Total $2,784.88 $2,784.88 This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. 10 If any conflict should arise between this summary and the Plan, the Plan's Certificate will govern in all cases.