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Document Blackfoot_doc_c21c540bb2

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Employee Contributions Premiums if tobacco cessation is completed Premiums if health assessment & tobacco cessation is completed Employee Contributions Premiums if health assessment is completed EE Contribution $80 $50 $0 $30 $0 EE/Spouse $290 $170 $120 $240 $120 Employee/Child $110 $80 $30 $60 $30 Employee/Children $270 $160 $110 $138 $110 Employee/Family $450 $250 $200 $400 $200 Employee Medical Premiums 2022 Employee Status Tobacco User Non-Tobacco User