1.2 FY 2016-17 MEDICAL PLANS EXHIBIT B PREMIUM RATES FINAL.DOCX
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Employee Benefits – Plan Year 2017 Premium Rates – Exhibit B FY 2016-17 Combined Medical, Prescription and Behavioral Health Full-time Active Employees Monthly Monthly Monthly Employee Monthly Total Employer Employee Premium Less Plan Tier Premium Premium Premium all Incentives * Employee 637.34 556.56 80.78 20.78 Health Maintenance Employee + Spouse 1,231.56 1,076.08 155.48 95.48 Organization Employee + Child(ren) 1,013.26 889.56 123.70 63.70 (HMO) Employee + Family 1,608.06 1,395.24 212.82 152.82 Employee 660.14 556.56 103.58 43.58 Preferred Provider Employee + Spouse 1,301.68 1,076.08 225.60 165.60 Organization Employee + Child(ren) 1,076.58 889.56 187.02 127.02 (PPO) Employee + Family 1,708.52 1,395.24 313.28 253.28 High Employee 622.14 556.56 65.58 5.58 Deductible Employee + Spouse 1,162.28 1,076.08 86.20 26.20 Health Plan w/ Employee + Child(ren) 966.54 889.56 76.98 16.98 HSA (HDHP) Employee + Family 1,509.88 1,395.24 114.64 54.64 * Subject to separate Board Approval Part-Time Active Employees Monthly Monthly Monthly Employee Monthly Total Employer Employee Premium Less Plan Tier Premium Premium Premium all Incentives * Employee 637.34 278.28 359.06 299.06 Health Maintenance Employee + Spouse 1,231.56 538.04 693.52 633.52 Organization Employee + Child(ren) 1,013.26 444.78 568.48 508.48 (HMO) Employee + Family 1,608.06 697.62 910.44 850.44 Employee 660.14 278.28 381.86 321.86 Preferred Provider Employee + Spouse 1,301.68 538.04 763.64 703.64 Organization Employee + Child(ren) 1,076.58 444.78 631.80 571.80 (PPO) Employee + Family 1,708.52 697.62 1,010.90 950.90 High Employee 622.14 278.28 343.86 283.86 Deductible Employee + Spouse 1,162.28 538.04 624.24 564.24 Health Plan w/ Employee + Child(ren) 966.54 444.78 521.76 461.76 HSA (HDHP) Employee + Family 1,509.88 697.62 812.26 752.26 FY 2016-17 Medical Premium Reduction Wellness Incentives Full-time Active Employees and Part Time Active Employees Monthly Monthly Monthly Total Employer Employee Plan Tier Premium Premium Premium Wellness Participation All Medical (Maximum amount – criteria to Plans be defined) (60.00) 0.00 (60.00)