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Page 4. <br /> ST.JOSEPH'S OMNI <br /> QUAL-MED"' HEALTH PLAN TAKECARE <br /> (QM) (SJO) (TC) <br /> Plan Monthly Plan Monthly Plan Monthly <br /> Code Rate Code Rate Code Rate <br /> Basic(B) <br /> Emp.only 2201 $156.07 2121 $144.18 521 $162.00 <br /> Emp. & 1 dep. 2202 315.62 2122 288.36 522 302.00 <br /> Emp. & 2+deps. 2203 414.92 2123 374.87 523 414.25 <br /> Supplement To Medicare(SM) <br /> Emp.only 2211 120.11 2131 125.00 191 134.00 <br /> Emp. & 1 dep. 2212 240.22 2132 250.00 192 254.00 <br /> Emp. & 2+deps. 2213 360.33 2133 375.00 193 339.00 <br /> Combination (B&SM) <br /> Emp. (SM), 1 dep. (B) 2214 279.66 2134 269.18 194 274.00 <br /> Emp. (SM), 2+deps. (B) 2215 378.96 2135 355.69 195 386.25 <br /> Emp. & 1 dep. (SM), 1+deps. (B) 2216 339.52 2136 336.51 196 366.25 <br /> Emp. (B), 1 dep. (SM) 2217 276.18 2137 269.18 197 282.00 <br /> Emp.(B), 2+deps. (SM) 2218 396.29 2138 394.18 198 367.00 <br /> Emp. & 1+dep. (B), 1 dep.(SM) 2219 375.48 2139 355.69 199 394.25 <br /> TRAVELERS <br /> HEALTH NETWORK VALUCARE <br /> (THN) (VC) <br /> Plan Monthly Plan Monthly <br /> Code Rate Code Rate <br /> Basic(B) <br /> Emp.only 2641 $150.10 2601 $167.00 <br /> Emp. & 1 dep. 2642 298.70 2602 321.00 <br /> Emp. & 2+ deps. 2643 393.28 2603 425.00 <br /> Supplement To Medicare(SM) <br /> Emp.only 2471 132.38 2481 129.00 <br /> Emp. & 1 dep. 2472 264.76 2482 259.00 <br /> Emp. & 2+deps. 2473 397.14 2483 349.00 ` <br /> Combination (B &SM) <br /> Emp.(SM), 1 dep. (B) 2474 280.98 2484 283.00 <br /> Emp. (SM), 2+deps.(B) 2475 375.56 2485 387.00 <br /> Emp. & 1 dep. (SM), 1+deps. (B) 2476 359.34 2486 363.00 <br /> Emp. (B), 1 dep. (SM) 2477 282.48 2487 297.00 <br /> Emp. (B), 2+deps. (SM) 2478 414.86 2488 387.00 <br /> Emp. & 1+dep. (B), 1 dep. (SM) 2479 377.06 2489 401.00 <br /> "' Formerly HEALS Health Plan <br /> 31 <br />