Cost Sharing Instructions: Cost sharing approaches for medical, dental,
and vision coverage vary greatly. For each of the plans offered, please indicate what percent of the premium the
Employer pays. While it is understood that there are different categories, please match
your organization's premium categories as closely as possible to the three listed groups (Employee Only - [EE],
Employee plus One - [EE+1], and Employee plus Family - [EE+Fam]).
If your organization has a category such as Employee+Child or Employee+Spouse, then select EE+1. For Employee+Children,
select EE+Fam. In determining the % employer contributions, if you have more than one category that fits one of
the three groups, average them. For example, if you have EE+1 that fits your employee+spouse and employee+child categories,
add the two % employer premium amounts and divide by two.
If your organization offers or plans to offer the benefit, but doesn't contribute to the premiums in any one category,
indicate such by placing 0% in the column. If the organization doesn't offer the benefit at all, leave the cost sharing columns
for that benefit blank.
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