Couple or Parent/Child(ren)

Estimated Required Contribution Couple or Parent/Child(ren) Coverage Member/Spouse/Partner or Parent/Child(ren)
Input the current year of the Ch. 78 implementation phase:	Year 1 2 3 4
Input your Annual Salary:	$
Select the range that reflects your Annual Salary:	$  less than 25,000 25,000-29,999.99 30,000-34,999.99 35,000-39,999.99 40,000-44,999.99 45,000-49,999.99 50,000-54,999.99 55,000-59,999.99 60,000-64,999.99 65,000-69,999.99 70,000-74,999.99 75,000-79,999.99 80,000-84,999.99 85,000-99,999.99 100,000 and over
Input your total MONTHLY premium:	$
Select the number of paychecks you receive per year (Payment Mode):	20 22 24 26 52
This is your premium contribution %:	0.00%
You pay the GREATER of the two numbers below:	Contribution
The Required Health Care Contribution is calculated at:	$0.00 per pay period ($0.00 annualized)
The minimum contribution based on 1.5% of salary is:	$0.00 per pay period ($0.00 annualized)

Note: this calculator is for informational purposes only. All calculations are estimates and may differ from the actual amounts deducted from payroll.