BI-WEEKLY EMPLOYEE CONTRIBUTIONS Tier Medical Base Plan Medical Buy-Up Plan Employee Only $62.82 $104.66 Employee + Spouse $128.41 $213.92 Employee + Child(ren) $104.22 $173.63 Family $181.99 $303.19 Tier Dental Plan Vision Plan Employee Only $2.38 $2.64 Employee + Spouse $4.76 $5.01 Employee + Child(ren) $4.82 $5.86 Family $7.52 $8.26 27 27