|
Total City
<br />Contribution
<br />Option B
<br />$517.14
<br />$784.00
<br />$784.00
<br />$784.00
<br />$831.56
<br />$1,092.00
<br />$1,092.00
<br />$1,092.00
<br />$831.56
<br />$1,176.00
<br />$1,176.00
<br />$1,176.00
<br />$831.56
<br />$1,358.00
<br />$1,358.00
<br />$1,358.00
<br />I 00'S6Z$ 1
<br />Employee Employee
<br />City Cost for Cost for City
<br />ACCORD AWARE Contribution to Accord Aware Contribution to
<br />Health Plan Type /Tier (Per Month) Premium Premimum Premium Network Network VEBA
<br />Single Plans
<br />BCBS 100% $30.00 co -pay $972.00 $1,008.50 $517.14 $454.86 $491.36 NA
<br />BCBS $1500 Ded. Plan w /VEBA $825.00 $855.50 $654.00 $171.00 $201.50 $130.00
<br />BCBS $2500 Ded. Plan w /VEBA $760.00 $788.50 $654.00 $106.00 $134.50 $130.00
<br />BCBS $4000 Ded. Plan w /VEBA $670.00 $695.00 $629.00 $41.00 $66.00 $155.00
<br />Employee + Spouse Plans
<br />BCBS 100% $30.00 co -pay $2,041.50 $2,118.50 $831.56 $1,209.94 $1,286.94 NA
<br />BCBS $1500/$3000 Ded. Plan w /VEBA $1,733.00 $1,797.50 $932.00 $801.00 $865.50 $160.00
<br />BCBS $2500/$5000 Ded. Plan w /VEBA $1,596.50 $1,656.50 $932.00 $664.50 $724.50 $160.00
<br />BCBS $4000/8000 Ded. Plan w /VEBA $1,408.00 $1,460.50 $932.00 $476.00 $528.50 $160.00
<br />Employee + Children Plans
<br />BCBS 100% $30.00 co -pay $1,945.00 $2,018.00 $831.56 $1,113.44 $1,186.44 NA
<br />BCBS $1500/$3000 Ded. Plan w /VEBA $1,649.50 $1,712.00 $1,016.00 $633.50 $696.00 $160.00
<br />BCBS $2500/$5000 Ded. Plan w /VEBA $1,520.00 $1,577.00 $1,016.00 $504.00 $561.00 $160.00
<br />BCBS $4000/8000 Ded. Plan w /VEBA $1,340.50 $1,391.00 $1,016.00 $324.50 $375.00 $160.00
<br />Family Plans
<br />BCBS 100% $30.00 co -pay $2,529.00 $2,623.50 $831.56 $1,697.44 $1,791.94 NA
<br />BCBS $1500/$3000 Ded. Plan w /VEBA $2,145.50 $2,225.00 $1,166.00 $979.50 $1,059.00 $192.00
<br />BCBS $2500/$5000 Ded. Plan w /VEBA $1,976.50 $2,051.50 $1,166.00 $810.50 $885.50 $192.00
<br />BCBS $4000/8000 Ded. Plan w /VEBA $1,743.00 $1,808.50 $1,166.00 $577.00 $642.50 $192.00
<br />saaAlef 1
<br />I (Waivers)I
<br />
|