Medical Plan Options 1 2018 medical plan options

2018 medical plan options The Walmart family is pretty big. Depending on where you

Key features of the HRA plans Get a special health reimbursement account credited by

How do the HRA plans work? Deductible Out-of-Pocket Max Once all HRA credit is

HRA Plan Rates Associate only Tobacco free $26. 10 One tobacco user $52. 20

HRA High Plan Rates Associate only Tobacco free One tobacco user $78. 50 $157.

Key features of an HSA plan Build a tax-free personal health savings account for

Health Savings Account Plan Rates Associate only Tobacco free $29. 10 One tobacco user

Key features of the e. Comm PPO Plan Manage in-network out-of-pocket medical expenses and

e. Comm PPO Plan Rates Associate only Tobacco free $32. 00 One tobacco user

Key features of an HMO plan HMOs offer convenient and coordinated care as well

Key features of the Kaiser CA e. Comm HMO Plan Deductible • $1, 000/associate

Kaiser CA e. Comm HMO Rates Associate only Tobacco free $29. 00 One tobacco

Key features of the Kaiser OR e. Comm HMO Plan Deductible • $1, 000/associate

Kaiser OR e. Comm HMO Rates Associate only Tobacco free $29. 00 One tobacco

Key features of the Kaiser e. Comm HMO Plan Deductible • $1, 000/associate •

Kaiser e. Comm HMO Rates Associate only Tobacco free $29. 00 One tobacco user

Key features of the Blue Care East/SE e. Comm HMO Plan Deductible • $1,

Blue Care East/SE e. Comm HMO Rates Associate only Tobacco free $29. 00 One

Key features of the Blue Care East/SE HMO Plan Deductible • $1, 000/associate •

Blue Care East/SE HMO Rates Associate only Tobacco free One tobacco user $77. 20

Key features of the Blue Care West HMO Plan Deductible • $1, 000/associate •

Blue Care East/SE e. Comm HMO Rates Associate only Tobacco free One tobacco user

Key features of the Health Net Excel. Care High HMO Plan Deductible • None

Health Net Excel. Care High HMO Rates Associate only Tobacco free One tobacco user

Key features of the Health Net Excel. Care Low HMO Plan Deductible • None

Health Net Low Excel. Care HMO Rates Associate only Tobacco free $36. 80 One

Key features of the Health Net Salud y Mas HMO Plan Services in CA

Health Net Salud y Mas HMO Rates Associate only Tobacco free $36. 30 One

Key features of the Kaiser CA High HMO Plan Deductible • $1, 000/ associate

Kaiser CA High HMO Rates Associate only Tobacco free One tobacco user $54. 70

Key features of the Kaiser CA Low HMO Plan Deductible • $1, 500/ associate

Kaiser CA Low HMO Rates Associate only Tobacco free $26. 40 One tobacco user

Key features of the Kaiser CO Low HMO Plan Deductible • $1, 500/ associate

Kaiser CO Low HMO Rates Associate only Tobacco free $41. 80 One tobacco user

Key features of the Kaiser GA Low HMO Plan Deductible • $1, 500/ associate

Kaiser GA Low HMO Rates Associate only Tobacco free $36. 30 One tobacco user

Key features of the Kaiser Mid-Atlantic Low HMO Plan Deductible • $1, 500/ associate

Kaiser Mid-Atlantic Low HMO Rates Associate only Tobacco free $34. 50 One tobacco user

Key features of the Kaiser WA Low HMO Plan Deductible • $1, 500/ associate

Kaiser WA Low HMO Rates Associate only Tobacco free One tobacco user $81. 70

Key features of the UPMC Health Plan HMO Plan Deductible • $1, 000/ associate

UPMC Health Plan HMO Rates Associate only Tobacco free One tobacco user $74. 70

Key features of a Select Network plan The Select Network Plan offers access to

Select Network Plan Rates Associate only Tobacco free $20. 80 One tobacco user $41.

What is an Accountable Care Plan (ACP)? The ACP offers an innovative, highly coordinated

Top doctors and hospitals When it comes to health care, we all want the

A care team working together for you • Feel confident knowing the ACP is

Banner ACP Features Associates have predictable and affordable copays, even before meeting the deductible,

Is the Banner ACP right for you? As you review your options, here are

The ACP difference If patient-centered care and predictable copays sound good to you, this

Banner ACP Rates Associate only Tobacco free $20. 90 One tobacco user $41. 80

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Medical Plan Options 1

2018 medical plan options The Walmart family is pretty big. Depending on where you are, you have a few medical plans to choose from. Health Reimbursement Health Savings Account (HRA) Plans Account (HSA) Plan 2 Health Maintenance Organizations (HMO)

Key features of the HRA plans Get a special health reimbursement account credited by Walmart to help them pay for eligible expenses. HRA Credit Annual Deductible Coinsurance Annual Out-of-Pocket Maximum 3 HRA Plan HRA High Plan $300 / $600 $500 / $1, 000 $2, 750 / $5, 500 $1, 750 / $3, 500 75% in-network 50% out-of-network $6, 850 / $13, 700

How do the HRA plans work? Deductible Out-of-Pocket Max Once all HRA credit is used, associates pay full price for eligible medical expenses until they meet the annual deductible Finally, once associates meet the annual out-ofpocket maximum, Walmart pays 100% of eligible medical expenses for the remainder of the plan year Associate Pays Walmart Pays Assoc. /Walmart Pays HRA Credit Coinsurance Walmart provides HRA credit which is automatically used first for eligible medical expenses After the annual deductible has been paid, both the associate and Walmart pays for eligible medical expenses. Associates pay 25% Walmart pays 75% 4

HRA Plan Rates Associate only Tobacco free $26. 10 One tobacco user $52. 20 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $124. 80 One tobacco user $150. 90 Two tobacco users $177. 00 Associate + Child(ren) Tobacco free $41. 90 One tobacco user $68. 00 Associate + Family 5 Tobacco free $146. 40 One tobacco user $172. 50 Two tobacco users $198. 60

HRA High Plan Rates Associate only Tobacco free One tobacco user $78. 50 $157. 00 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $265. 90 One tobacco user $344. 40 Two tobacco users $422. 90 Associate + Child(ren) Tobacco free $110. 80 One tobacco user $189. 30 Associate + Family 6 Tobacco free $284. 60 One tobacco user $363. 10 Two tobacco users $441. 60

Key features of an HSA plan Build a tax-free personal health savings account for use with eligible health care expenses. HSA contributions Triple tax benefit Walmart matches your contribution dollar for dollar up to $350 per year, or $700 if you cover dependents Using your HSA • HSA may be used for any IRS-approved health expenses • HSA dollars are yours to keep 7

Health Savings Account Plan Rates Associate only Tobacco free $29. 10 One tobacco user $58. 20 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $130. 50 One tobacco user $159. 60 Two tobacco users $188. 70 Associate + Child(ren) Tobacco free $45. 70 One tobacco user $74. 80 Associate + Family 8 Tobacco free $150. 70 One tobacco user $179. 80 Two tobacco users $208. 90

2018 medical plan options The Walmart family is pretty big. Depending on where you are, you have a few medical plans to choose from. e. Commerce PPO 9 Health Savings Account (HSA) Plan Health Maintenance Organizations (HMO)

Key features of the e. Comm PPO Plan Manage in-network out-of-pocket medical expenses and receive additional treatment options with a PPO plan. Deductible • $300/associate • $600/associate + dependents Out-of-pocket maximum • $1500/associate • $3000/associate + dependents Office copays • $15 PCP • $25 Specialist 10 Additional benefits • Chiropractic care • Transgender benefit coverage • Infertility treatment coverage

e. Comm PPO Plan Rates Associate only Tobacco free $32. 00 One tobacco user $64. 00 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $139. 00 One tobacco user $171. 00 Two tobacco users $203. 00 Associate + Child(ren) Tobacco free $54. 00 One tobacco user $86. 00 Associate + Family 11 Tobacco free $161. 00 One tobacco user $193. 00 Two tobacco users $225. 00

Key features of an HMO plan HMOs offer convenient and coordinated care as well as predictable and affordable copays for doctor visits Simple copays A fixed dollar amount for many services Administrative ease Most HMOs have streamlined administrative processes with their providers. Local providers Most HMOs cover care within the HMO network only, except for life-threatening emergencies. 12

Key features of the Kaiser CA e. Comm HMO Plan Deductible • $1, 000/associate • $2, 000/associate + dependents Out-of-pocket maximum • $6, 550/associate • $13, 100/associate + dependents Office copays • $35 PCP • $50 Specialist Hospital • 25% after deductible Pharmacy copays • $10 Generic • $50 Brand • 25% up to $350 Specialty 13

Kaiser CA e. Comm HMO Rates Associate only Tobacco free $29. 00 One tobacco user $58. 00 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $125. 00 One tobacco user $154. 00 Two tobacco users $183. 00 Associate + Child(ren) Tobacco free $49. 00 One tobacco user $78. 00 Associate + Family 14 Tobacco free $145. 00 One tobacco user $174. 00 Two tobacco users $203. 00

Key features of the Kaiser OR e. Comm HMO Plan Deductible • $1, 000/associate • $2, 000/associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $60 Specialist Hospital • 25% after deductible Pharmacy copays • $10 Generic • $50 Brand • 25% up to $350 Specialty 15

Kaiser OR e. Comm HMO Rates Associate only Tobacco free $29. 00 One tobacco user $58. 00 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $125. 00 One tobacco user $154. 00 Two tobacco users $183. 00 Associate + Child(ren) Tobacco free $49. 00 One tobacco user $78. 00 Associate + Family 16 Tobacco free $145. 00 One tobacco user $174. 00 Two tobacco users $203. 00

Key features of the Kaiser e. Comm HMO Plan Deductible • $1, 000/associate • $2, 000/associate + dependents Out-of-pocket maximum • $6, 550/associate • $13, 100/associate + dependents Office copays • $35 PCP • $50 Specialist Hospital • 25% after deductible Pharmacy copays • $10 Generic • $50 Brand • 25% up to $350 Specialty 17

Kaiser e. Comm HMO Rates Associate only Tobacco free $29. 00 One tobacco user $58. 00 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $125. 00 One tobacco user $154. 00 Two tobacco users $183. 00 Associate + Child(ren) Tobacco free $49. 00 One tobacco user $78. 00 Associate + Family 18 Tobacco free $145. 00 One tobacco user $174. 00 Two tobacco users $203. 00

Key features of the Blue Care East/SE e. Comm HMO Plan Deductible • $1, 000/associate • $2, 000/associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $50 after deductible Specialist Hospital • 20% after deductible Pharmacy copays • $10 Generic • $50 Brand 19

Blue Care East/SE e. Comm HMO Rates Associate only Tobacco free $29. 00 One tobacco user $58. 00 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $125. 00 One tobacco user $154. 00 Two tobacco users $183. 00 Associate + Child(ren) Tobacco free $49. 00 One tobacco user $78. 00 Associate + Family 20 Tobacco free $145. 00 One tobacco user $174. 00 Two tobacco users $203. 00

Key features of the Blue Care East/SE HMO Plan Deductible • $1, 000/associate • $2, 000/associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $50 after deductible Specialist Hospital • 20% after deductible Pharmacy copays • $10 Generic • $50 Brand 21

Blue Care East/SE HMO Rates Associate only Tobacco free One tobacco user $77. 20 $154. 40 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $318. 50 One tobacco user $395. 70 Two tobacco users $472. 90 Associate + Child(ren) Tobacco free $138. 90 One tobacco user $216. 10 Associate + Family 22 Tobacco free $374. 70 One tobacco user $451. 90 Two tobacco users $529. 10

Key features of the Blue Care West HMO Plan Deductible • $1, 000/associate • $2, 000/associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $50 after deductible Specialist Hospital • 20% after deductible Pharmacy copays • $200 individual; $400 family deductible • $10 Generic after deductible • $50 Brand after deductible 23

Blue Care East/SE e. Comm HMO Rates Associate only Tobacco free One tobacco user $77. 20 $154. 40 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $318. 50 One tobacco user $395. 70 Two tobacco users $472. 90 Associate + Child(ren) Tobacco free $138. 90 One tobacco user $216. 10 Associate + Family 24 Tobacco free $374. 70 One tobacco user $451. 90 Two tobacco users $529. 10

Key features of the Health Net Excel. Care High HMO Plan Deductible • None Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $75 Specialist Hospital • $1, 000 copay + 25% Pharmacy copays • $10 Generic • $50 Brand 25

Health Net Excel. Care High HMO Rates Associate only Tobacco free One tobacco user $56. 30 $112. 60 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $223. 20 One tobacco user $279. 50 Two tobacco users $335. 80 Associate + Child(ren) Tobacco free $118. 90 One tobacco user $175. 20 Associate + Family 26 Tobacco free $261. 30 One tobacco user $317. 60 Two tobacco users $373. 90

Key features of the Health Net Excel. Care Low HMO Plan Deductible • None Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $75 Specialist Hospital • $1, 500 copay + 25% Pharmacy copays • $10 Generic • $50 Brand 27

Health Net Low Excel. Care HMO Rates Associate only Tobacco free $36. 80 One tobacco user $73. 60 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $144. 10 One tobacco user $180. 90 Two tobacco users $217. 70 Associate + Child(ren) Tobacco free One tobacco user $75. 60 $112. 40 Associate + Family 28 Tobacco free $172. 50 One tobacco user $209. 30 Two tobacco users $246. 10

Key features of the Health Net Salud y Mas HMO Plan Services in CA Services in Mexico Deductible • None Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Out-of-pocket maximum • $1, 500/associate • $3, 000/two party • $4, 500/ family Office copays • $35 PCP • $75 Specialist Office copays • $10 PCP Hospital • $1, 000 copay + 25% Pharmacy copays • $10 Generic • $50 Brand 29 Hospital • 100% Pharmacy copays • $5 when filled at a SIMNSA

Health Net Salud y Mas HMO Rates Associate only Tobacco free $36. 30 One tobacco user $72. 60 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $171. 50 One tobacco user $207. 80 Two tobacco users $244. 10 Associate + Child(ren) Tobacco free $58. 10 One tobacco user $94. 40 Associate + Family 30 Tobacco free $201. 20 One tobacco user $237. 50 Two tobacco users $273. 80

Key features of the Kaiser CA High HMO Plan Deductible • $1, 000/ associate • $2, 000/ associate + dependents Out-of-pocket maximum • $6, 550/associate • $13, 100/associate + dependents Office copays • $35 PCP • $50 Specialist Hospital • 25% after deductible Pharmacy copays • $10 Generic • $50 Brand 31

Kaiser CA High HMO Rates Associate only Tobacco free One tobacco user $54. 70 $109. 40 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $220. 60 One tobacco user $275. 30 Two tobacco users $330. 00 Associate + Child(ren) Tobacco free One tobacco user $92. 40 $147. 10 Associate + Family 32 Tobacco free $261. 30 One tobacco user $316. 00 Two tobacco users $370. 70

Key features of the Kaiser CA Low HMO Plan Deductible • $1, 500/ associate • $3, 000/ associate + dependents Out-of-pocket maximum • $6, 550/associate • $13, 100/associate + dependents Office copays • $35 PCP • $50 Specialist Hospital • 25% after deductible Pharmacy copays • $10 Generic • $50 Brand 33

Kaiser CA Low HMO Rates Associate only Tobacco free $26. 40 One tobacco user $52. 80 Associate + spouse/partner Tobacco free Your cost per biweekly pay period $92. 70 One tobacco user $119. 10 Two tobacco users $145. 50 Associate + Child(ren) Tobacco free $39. 60 One tobacco user $66. 00 Associate + Family 34 Tobacco free $109. 60 One tobacco user $136. 00 Two tobacco users $162. 40

Key features of the Kaiser CO Low HMO Plan Deductible • $1, 500/ associate • $3, 000/ associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $75 Specialist Hospital • 25% after deductible Pharmacy copays • $15 Generic • $50 Brand 35

Kaiser CO Low HMO Rates Associate only Tobacco free $41. 80 One tobacco user $83. 60 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $134. 60 One tobacco user $176. 40 Two tobacco users $218. 20 Associate + Child(ren) Tobacco free $57. 50 One tobacco user $99. 30 Associate + Family 36 Tobacco free $169. 30 One tobacco user $211. 10 Two tobacco users $252. 90

Key features of the Kaiser GA Low HMO Plan Deductible • $1, 500/ associate • $3, 000/ associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $75 Specialist Hospital • 25% after deductible Pharmacy copays • $10 Generic • $50 Brand 37

Kaiser GA Low HMO Rates Associate only Tobacco free $36. 30 One tobacco user $72. 60 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $171. 50 One tobacco user $207. 80 Two tobacco users $244. 10 Associate + Child(ren) Tobacco free $58. 10 One tobacco user $94. 40 Associate + Family 38 Tobacco free $201. 20 One tobacco user $237. 50 Two tobacco users $273. 80

Key features of the Kaiser Mid-Atlantic Low HMO Plan Deductible • $1, 500/ associate • $3, 000/ associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $75 Specialist Hospital • 25% after deductible Pharmacy copays • $15 Generic • $50 Brand 39

Kaiser Mid-Atlantic Low HMO Rates Associate only Tobacco free $34. 50 One tobacco user $69. 00 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $118. 30 One tobacco user $152. 80 Two tobacco users $187. 30 Associate + Child(ren) Tobacco free $51. 50 One tobacco user $86. 00 Associate + Family 40 Tobacco free $141. 10 One tobacco user $175. 60 Two tobacco users $210. 10

Key features of the Kaiser WA Low HMO Plan Deductible • $1, 500/ associate • $3, 000/ associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $25 PCP • $50 Specialist Hospital • 20% after deductible Pharmacy copays • $10 Generic • $40 Brand 41

Kaiser WA Low HMO Rates Associate only Tobacco free One tobacco user $81. 70 $163. 40 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $278. 40 One tobacco user $360. 10 Two tobacco users $441. 80 Associate + Child(ren) Tobacco free $129. 50 One tobacco user $211. 20 Associate + Family 42 Tobacco free $322. 70 One tobacco user $404. 40 Two tobacco users $486. 10

Key features of the UPMC Health Plan HMO Plan Deductible • $1, 000/ associate • $2, 000/ associate + dependents Out-of-pocket maximum • $6, 850/associate • $13, 700/associate + dependents Office copays • $35 PCP • $75 Specialist Hospital • 25% after deductible Pharmacy copays • $10 Generic • $50 Brand 43

UPMC Health Plan HMO Rates Associate only Tobacco free One tobacco user $74. 70 $149. 40 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $268. 70 One tobacco user $343. 40 Two tobacco users $418. 10 Associate + Child(ren) Tobacco free $118. 40 One tobacco user $193. 10 Associate + Family 44 Tobacco free $311. 60 One tobacco user $386. 30 Two tobacco users $461. 00

Key features of a Select Network plan The Select Network Plan offers access to top quality doctors and hospitals and convenient copays, all at the lowest cost. Simple copays • $35 copay for doctor visits • $75 copay for specialists visits Lowest costing plan available – starting at less than $21 a paycheck Local providers Plan covers care within the local network only, except for life-threatening emergencies. 45

Select Network Plan Rates Associate only Tobacco free $20. 80 One tobacco user $41. 60 Associate + spouse/partner Your cost per biweekly pay period Tobacco free $110. 00 One tobacco user $130. 80 Two tobacco users $151. 60 Associate + Child(ren) Tobacco free $34. 30 One tobacco user $55. 10 Associate + Family 46 Tobacco free $128. 90 One tobacco user $149. 70 Two tobacco users $170. 50

What is an Accountable Care Plan (ACP)? The ACP offers an innovative, highly coordinated approach to health care. TOP DOCTORS AND HOSPITALS Feel confident with the ACP because it consists of some of the very best and hospitals in your area. 47 ACP CARE TEAM WORKING TOGETHER FOR YOU PREDICTABLE AND AFFORDABLE COPAYS Rest assured that your care team has everything it needs and works together for you. Know before you go. ACPs have low copays.

Top doctors and hospitals When it comes to health care, we all want the best. • Banner Health System is one of the best in your area • Choose from some of the top local doctors • Doctors will care for your total health, not just treat what’s wrong • Let the highest quality care get you back on your feet, doing what matters most to you 48 ACP

A care team working together for you • Feel confident knowing the ACP is built around a team approach to your and your family’s healthcare • Choose your primary care doctor, who guides your care and keeps you healthy Physical therapy Lab work Primary care • Doctors and hospitals use the same computer system for overall coordinated care delivery Hospitalization Pharmacy Associates receive coordinated, personalized care conveniently through one health system. 49 ACP

Banner ACP Features Associates have predictable and affordable copays, even before meeting the deductible, along with 100 percent covered preventive care. ACP Care and services Including doctor visits, diagnostic tests, hospitalization, behavioral health Annual deductible (except for preventive care) Associate only Associate + dependents Annual out-of-pocket maximum Office visits: $35 copay before deductible Specialists, urgent care: $75 copay before deductible Other in-network care: 75% after deductible $3, 000 $6, 850 person $13, 700 per family Generic drugs (up to 30 -day supply) $4 Brand-name drug $50 or 25% of allowed cost (whichever is greater) Specialty drugs $50 or 20% of allowed cost (whichever is greater) DON’T PAY FULL PRICE FOR PRESCRIPTIONS. To get the lowest cost, you’ll need to fill your prescriptions at a Walmart or Sam’s Club pharmacy. 50 ACP

Is the Banner ACP right for you? As you review your options, here are some points to remember: • Complex health care needs - If you already see a lot of doctors or take multiple medications, the accountable care approach can make life easier and your health better. • Locals only - Network providers are only available locally, so if you wish to cover eligible dependents who live elsewhere, the plan may not be a good fit for you. Out-of-network services are allowed for emergency situations. 51 ACP Think of an ACP as a whole team of medical experts coordinating care for a better you.

The ACP difference If patient-centered care and predictable copays sound good to you, this plan could be your best choice for 2018. Trust in best doctors Comprehensive service of a care team Simplicity of low copays Other plan choices generally result in visits to multiple facilities for care and a variety of doctors not interacting to give them the same seamless service of the ACP. 52 ACP

Banner ACP Rates Associate only Tobacco free $20. 90 One tobacco user $41. 80 Associate + spouse/partner Tobacco free Your cost per biweekly pay period $99. 80 One tobacco user $120. 70 Two tobacco users $141. 60 Associate + Child(ren) Tobacco free $33. 50 One tobacco user $54. 40 Associate + Family 53 Tobacco free $117. 10 One tobacco user $138. 00 Two tobacco users $158. 90