Cost of Coverage – Liberty Healthcare

Effective Plan Dates: April 1, 2025 - March 31, 2026

Cost of Coverage

Medical

Coverage Tier	EE Cost PP
Basic
Employee Only	$66.51
Employee + Spouse	$262.30
Employee + Child(ren)	$171.58
Employee + Family	$355.85

Coverage Tier	EE Cost PP
Standard
Employee Only	$108.33
Employee + Spouse	$341.22
Employee + Child(ren)	$234.69
Employee + Family	$461.60

Coverage Tier	EE Cost PP
Premium
Employee Only	$156.43
Employee + Spouse	$459.03
Employee + Child(ren)	$325.83
Employee + Family	$619.81
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Coverage Tier	EE Cost PP
HPN
Employee Only	$55.38
Employee + Spouse	$218.31
Employee + Child(ren)	$143.08
Employee + Family	$296.31

Dental

	Coverage Tier	EE Cost PP
Core		All Emp
	Employee Only	$13.76
	Employee + Family	$27.64

	Coverage Tier	EE Cost PP
Buy-Up		All Emp
	Employee Only	$18.46
	Employee + Family	$40.15

Vision

Coverage Tier	EE Cost PP
	All Emp
Employee Only	$3.72
Employee + 1	$7.14
Employee + Family	$10.50

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Benefits Disclaimer

This Benefits Website provides general information for our benefit eligible employees; however, more detailed information is available within the plan documents and legal contracts between our company and the insurance providers. In case of any discrepancy between this Benefits Website and the plan documents, the plan documents always govern and determine your exact benefits. In addition, the company reserves the right to modify or terminate any benefit plan at any time. Benefits are not a guarantee of employment.