|
Number of months coverage |
Member Only |
Addition of one dependent |
Member plus one dependent |
Addition of two or more dependents |
Member plus two or more dependents |
|
1 |
$60 |
$108 |
$168 |
$216 |
$276 |
|
2 |
$120 |
$216 |
$336 |
$432 |
$552 |
|
3 |
$180 |
$324 |
$504 |
$648 |
$828 |
|
4 |
$240 |
$432 |
$672 |
$864 |
$1,104 |
|
5 |
$300 |
$540 |
$840 |
$1,080 |
$1,380 |
|
6 |
$360 |
$648 |
$1,008 |
$1,296 |
$1,656 |
|
7 |
$420 |
$756 |
$1,176 |
$1,512 |
$1,932 |
|
8 |
$480 |
$864 |
$1,344 |
$1,728 |
$2,208 |
|
9 |
$540 |
$972 |
$1,512 |
$1,944 |
$2,484 |
|
10 |
$600 |
$1,080 |
$1,680 |
$2,160 |
$2,760 |
|
11 |
$660 |
$1,188 |
$1,848 |
$2,376 |
$3,036 |
|
12 |
$720 |
$1,296 |
$2,016 |
$2,592 |
$3,312 |
|
|
A |
B |
C |
D |
E |
|
|
|
|
A + B = C |
|
A + D = E |
|
|
|
