Benefits Enrollment 2012-2013

2013 Medical Premiums
for Active Full-time and Regular Part-time Salaried Employees w/o Wellness Incentive Credit*

Open Access Plus (OAP) and Choice Fund

Open Access Plus (OAP)

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$38.15

$152.60

Employee + 1

$68.50

$274.00

Employee + 2 or more

$98.90

$395.60

Choice Fund

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$23.25

$93.00

Employee + 1

$47.45

$189.80

Employee + 2 or more

$63.00

$252.00

2013 Medical Premiums
for Active Full-time and Regular Part-time Salaried Employees with Wellness Incentive Credit*

Open Access Plus (OAP) and Choice Fund

Open Access Plus (OAP)

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$30.65

$122.60

Employee + 1

$61.00

$244.00

Employee + 2 or more

$91.40

$365.60

Choice Fund

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$15.75

$63.00

Employee + 1

$39.95

$159.80

Employee + 2 or more

$55.50

$222.00

2013 Medical Premiums
for Active Casual Employees

Open Access Plus (OAP) and Choice Fund

Open Access Plus (OAP)

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$114.40

$457.60

Employee + 1

$205.50

$822.00

Employee + 2 or more

$296.65

$1,186.60

Choice Fund

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$69.75

$279.00

Employee + 1

$142.30

$569.20

Employee + 2 or more

$189.00

$756.00

2013 Medical Premiums
for Active Full-Time Hourly Employees

Point of Service (POS) and Open Access (OA)

Point of Service (POS)

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$32.35

$129.40

Employee + 1

$63.50

$254.00

Employee + 2 or more

$97.15

$388.60

Open Access (OA)

Employee Cost Per Week

Employee Cost Per Month

Employee Only

$37.45

$149.80

Employee + 1

$74.90

$299.60

Employee + 2 or more

$112.30

$449.20

2013 Medical Premiums
for Active Full-time and Regular Part-time Salaried Employees, and Active Full-Time Hourly Employees Retired on or Before January 1, 2013

Point of Service (POS) and Open Access

Point of Service (POS)

Retiree Shared Cost Per Month

Retiree Full Cost Per Month

Employee Only

$156.25

$646.25

$311.50

$1,270.00

Employee + 2 or more

$470.75

$1,942.50

Open Access

Retiree Shared Cost Per Month

Retiree Full Cost Per Month

Employee Only

$186.75

$748.75

Employee + 1

$374.25

$1,497.50

Employee + 2 or more

$562.00

$2,246.25

2013 Medical Premiums
for Active Full-time and Regular Part-time Salaried Employees Retiring on February 1, 2013 or After

Open Access Plus (OAP) and Choice Fund

Open Access Plus (OAP)

Retiree Shared Cost Per Month

Retiree Full Cost Per Month

Employee Only

$190.63

$762.50

Employee + 1

$342.50

$1,370.00

Employee + 2 or more

$494.38

$1,977.50

Choice Fund

Retiree Shared Cost Per Month

Retiree Full Cost Per Month

Employee Only

$116.25

$465.00

Employee + 1

$237.19

$948.75

Employee + 2 or more

$315.00

$1,260.00

2013 Medical Premiums
for Active Full-Time Hourly Employees Retiring on February 1, 2013 or After

Point of Service (POS) and Open Access

Point of Service (POS)

Retiree Shared Cost Per Month

Retiree Full Cost Per Month

Employee Only

$156.25

$646.25

Employee + 1

$311.50

$1,270.00

Employee + 2 or more

$470.75

$1,942.50

Open Access

Retiree Shared Cost Per Month

Retiree Full Cost Per Month

Employee Only

$186.75

$748.75

Employee + 1

$374.25

$1,497.50

Employee + 2 or more

$562.00

$2,246.25