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<br /> <br /> <br /> <br /> <br /> <br /> 1I Between 1000 and 1499-Self Insured 1 <br /> health plan $6,500 $7,500 $750/Stud See Below <br /> 11 a Between 1000 and 1499-per additional <br /> self insured health or retirement Ian $1,000 $1,000 $750/Stud See Below <br /> 12 Between 1500 and 1999-Insured 1 health $5,000 $6,000 $750/Stud See Below <br /> Ian <br /> 12a Between 1500 and 1999-per additional <br /> health or retirement plan $19000 $1,000 $750/Stud See Below <br /> 13 Between 1500 and 1999-Self Insured I <br /> health plan $6,500 $7,500 $750/Stud See Below <br /> 13a Between 1500 and 1999-per additional See Below <br /> self insured health or retirement Ian $1,000 $1,000 $750/Stud <br /> 14 Between 2000 and 2499-Insured 1 health <br /> Ian $59000 $6,000 $750/Stud See Below <br /> 14a Between 2000 and 2499-per additional $1,000 $1,000 $750/Stud See Below <br /> health or retirement lan <br /> 15 Between 2000 and 2499-Self Insured 1 <br /> health plan $6,500 $7,500 $750/Stud See Below <br /> 15a Between 2000 an d 2499-per additional See Below <br /> self insured health or retirement Ian $1,000 $1,000 $750/Stud <br /> 16 Between 2500 and 5000-Self Insured 1 $7,000 $8,000 $750/Stud See Below <br /> health plan <br /> 16a Between 2500 and 5000-per additional See Below <br /> self insured health or retirement plan $1,500 $1,500 $750/Stud <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 00111? <br />