1.2 FY 2019-20 MEDICAL PLANS EXHIBIT B PREMIUM RATES FINAL.DOCX
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Employee Benefits – Plan Year 2020 Premium Rates – Exhibit B FY 2019-20 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 684.60 601.80 82.80 22.80 Health Employee + Spouse 1,327.46 1,168.08 159.38 99.38 Maintenance Organization Employee + Child(ren) 1,091.28 964.48 126.80 66.80 (HMO) Employee + Family 1,734.76 1,516.62 218.14 158.14 Employee 716.60 610.92 105.68 45.68 Preferred Employee + Spouse 1,392.38 1,162.64 229.74 169.74 Provider Organization Employee + Child(ren) 1,144.12 953.42 190.70 130.70 (PPO) Employee + Family 1,820.58 1,501.48 319.10 259.10 High Employee 673.48 605.76 67.72 7.72 Deductible Employee + Spouse 1,304.88 1,215.02 89.86 29.86 Health Plan w/ HSA - Cigna Employee + Child(ren) 1,072.92 993.02 79.90 19.90 (HDHP) Employee + Family 1,704.96 1,585.46 119.50 59.50 High Employee 673.48 605.76 67.72 7.72 Deductible Employee + Spouse 1,304.88 1,215.02 89.86 29.86 Health Plan w/ HSA - UHG Employee + Child(ren) 1,072.92 993.02 79.90 19.90 (HDHP) Employee + Family 1,704.96 1,585.46 119.50 59.50 Part-Time Active Employees Monthly Monthly Monthly Employee Monthly Total Employer Employee Premium After Plan Tier Premium Premium Premium $60 Incentive Employee 684.60 300.90 383.70 323.70 Health Employee + Spouse 1,327.46 584.04 743.42 683.42 Maintenance Organization Employee + Child(ren) 1,091.28 482.24 609.04 549.04 (HMO) Employee + Family 1,734.76 758.32 976.44 916.44 Employee 716.60 305.46 411.14 351.14 Preferred Employee + Spouse 1,392.38 581.32 811.06 751.06 Provider Organization Employee + Child(ren) 1,144.12 476.72 667.40 607.40 (PPO) Employee + Family 1,820.58 750.74 1,069.84 1,009.84 High Employee 673.48 302.88 370.60 310.60 Deductible Employee + Spouse 1,304.88 607.52 697.36 637.36 Health Plan w/ HSA - Cigna Employee + Child(ren) 1,072.92 496.52 576.40 516.40 (HDHP) Employee + Family 1,704.96 792.74 912.22 852.22 High Employee 673.48 302.88 370.60 310.60 Deductible Employee + Spouse 1,304.88 607.52 697.36 637.36 Health Plan w/ HSA - UHG Employee + Child(ren) 1,072.92 496.52 576.40 516.40 (HDHP) Employee + Family 1,704.96 792.74 912.22 852.22