AREA

EMPLOYEE ONLY

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD

EMPLOYEE
+2 or 3 DEPENDENTS

EMPLOYEE +4 OR MORE DEPENDENTS

1

$30.36

$59.90

$49.18

$84.48

$101.84

2

$33.08

$64.86

$53.60

$92.08

$111.02

3

$36.08

$70.70

$58.44

$100.40

$121.40

4

$39.32

$77.08

$63.70

$109.44

$131.94

5

$42.88

$84.04

$69.46

$119.32

$143.86

6

$46.74

$91.58

$75.70

$130.08

$156.82