Licensed Tiered Insurance Rates for 2020-2021


My Tier: Choose those who will be covered for insurance
My Medical:
My Dental:
My Vision:
Dependent Double-Coverage: Please indicate how many dependents
will be double-covered:
Life: 5.20
Total Plan Costs:
ESD Contribution:
Employee Out of Pocket: Total amount out of your monthly pay check.

HSA Contribution Paid by ESD Monthly:
$100.00