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EDM, Inc.
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EMPLOYEE COST PER PAY PERIOD
Medical
Plan 1
QF7
Plan 2
AHBA
Employee
$0
$0
Employee & Spouse
$299.15
$273.40
Employee & Child(ren)
$244.76
$223.70
Family
$573.28
$523.94
Dental
Employee
$0
Employee & Spouse
$20.69
Employee & Child(ren)
$27.68
Family
$48.37
Employee
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Employee
Monthly Cost
Spouse
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Spouse Monthly
Cost
Child(ren)
$__________ ÷ 1,000 X $__________ = $___________
Amount of
Coverage
Unit Cost from
Rate Table
Child(ren)
Monthly Cost
How to Calculate Your Voluntary Life Premium
Vision
Employee
$0
Employee & Spouse
$2.56
Employee & Child(ren)
$2.85
Family
$5.52