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J <br />3 <br />F -6 Page 77 <br />Budgeted Rates for 2016 - 2017 <br />OAP - Base Rate <br />HSA - Base Rate <br />Total <br />Cost <br />Employee Cost <br />Employee Cost <br />Employee /Retiree <br />$643.50 <br />$100.00 <br />$100.00 <br />Spouse <br />$482.00 <br />$450.00 <br />Children <br />$401.00 <br />$340.00 <br />Family <br />$772.00 <br />$690.00 <br />OAP - Tier 1 Discount <br />HSA - Tier 1 Discount <br />Tobacco User <br />Tobacco User <br />or <br />or <br />Non -Aim Participant <br />Non -AIM Participant <br />Total <br />Cost <br />Employee Cost <br />Employee Cost <br />Employee /Retiree <br />$643.50 <br />$50.00 <br />$50.00 <br />Spouse <br />$432.00 <br />$400.00 <br />Children <br />$351.00 <br />$290.00 <br />Family <br />$722.00 <br />$640.00 <br />OAP - Tier 2 Discount <br />HSA — Tier 2 Discount <br />Non - Tobacco User and <br />Non- Tobacco User and <br />AIM Participant <br />AIM Participant <br />Total <br />Cost <br />Employee Cost <br />Employee Cost <br />Employee /Retiree <br />$643.50 <br />$0.00 <br />$0.00 <br />Spouse <br />$382.00 <br />$350.00 <br />Children <br />$301.00 <br />$240.00 <br />Family <br />$672.00 <br />$590.00 <br />3 <br />F -6 Page 77 <br />