Chapter 78 Calculator for

Estimated Required Contribution Year 4
The current year of the Ch. 78 implementation phase:	Year: 4
Select each program's plan and tier: Medical Program Select a plan: Direct 10 Direct 15 Select a tier: Single 2 Adults Family Parent/Child(ren) - Pharmacy Program Select a plan: All Employees Select a tier: Single 2 Adults Family Parent/Child(ren) - Dental Program Select a plan: Waive Select a tier: Single 2 Adults Family Parent/Child(ren) - Vision Program Select a plan: Waive Select a tier: Single 2 Adults Family Parent/Child(ren) -
This is your monthly premium total (medical + pharmacy + dental + vision programs):	Monthly Premium -
Input your Annual Salary:	Annual Salary $
Select the number of paychecks you receive per year:	Payroll Frequency 20 24
This is your premium contribution %:	Prem Contr. % Medical: - Pharmacy: - Dental: - Vision: -
/
	Contribution
The Required Health Care Contribution is calculated at:	Medical: - Pharmacy: - Dental: - Vision: - Total: -

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