1.2 FY 2020-21 MEDICAL PLANS EXHIBIT B PREMIUM RATES.DOCX

Employee Benefits – Plan Year 2021 Premium Rates – Exhibit B
FY 2020-21 Combined Medical, Prescription and Behavioral Health
Full-time Active Employees
Monthly
Monthly Monthly Employee
Monthly Total Employer Employee Premium After
Plan Tier Premium Premium Premium $60 Incentive
Employee 745.06 660.26 84.80 24.80
Health Employee + Spouse 1,450.18 1,281.62 168.56 108.56
Maintenance
Organization Employee + Child(ren) 1,191.14 1,058.24 132.90 72.90
(HMO) Employee + Family 1,896.92 1,664.00 232.92 172.92
Employee 779.88 670.18 109.70 49.70
Preferred Employee + Spouse 1,520.80 1,275.40 245.40 185.40
Provider
Organization Employee + Child(ren) 1,248.62 1,045.98 202.64 142.64
(PPO) Employee + Family 1,990.28 1,647.04 343.24 283.24
High Employee 727.34 659.00 68.34 8.34
Deductible Employee + Spouse 1,414.16 1,321.80 92.36 32.36
Health Plan w/
HSA - Cigna Employee + Child(ren) 1,161.84 1,080.30 81.54 21.54
(HDHP) Employee + Family 1,849.38 1,724.84 124.54 64.54
High Employee 727.34 659.00 68.34 8.34
Deductible Employee + Spouse 1,414.16 1,321.80 92.36 32.36
Health Plan w/
HSA - UHG Employee + Child(ren) 1,161.84 1,080.30 81.54 21.54
(HDHP) Employee + Family 1,849.38 1,724.84 124.54 64.54
Part-Time Active Employees
Monthly
Monthly Monthly Employee
Monthly Total Employer Employee Premium After
Plan Tier Premium Premium Premium $60 Incentive
Employee 745.06 330.14 414.92 354.92
Health Employee + Spouse 1,450.18 640.82 809.36 749.36
Maintenance
Organization Employee + Child(ren) 1,191.14 529.12 662.02 602.02
(HMO) Employee + Family 1,896.92 832.00 1,064.92 1,004.92
Employee 779.88 335.10 444.78 384.78
Preferred Employee + Spouse 1,520.80 637.70 883.10 823.10
Provider
Organization Employee + Child(ren) 1,248.62 523.00 725.62 665.62
(PPO) Employee + Family 1,990.28 823.52 1,166.76 1,106.76
High Employee 727.34 329.50 397.84 337.84
Deductible Employee + Spouse 1,414.16 660.92 753.24 693.24
Health Plan w/
HSA - Cigna Employee + Child(ren) 1,161.84 540.16 621.68 561.68
(HDHP) Employee + Family 1,849.38 862.44 986.94 926.94
High Employee 727.34 329.50 397.84 337.84
Deductible Employee + Spouse 1,414.16 660.92 753.24 693.24
Health Plan w/
HSA - UHG Employee + Child(ren) 1,161.84 540.16 621.68 561.68
(HDHP) Employee + Family 1,849.38 862.44 986.94 926.94