1.2 FY 2021-22 MEDICAL PLANS EXHIBIT B PREMIUM RATES.DOCX

Employee Benefits – Plan Year 2022 Premium Rates – Exhibit B
FY 2021-22 Combined Medical, Prescription and Behavioral Health
Full-time Active Employees
 Plan
 Tier
 Monthly Total 
Premium
 Monthly 
Employer 
Premium 
 Monthly 
Employee 
Premium 
 Monthly 
Employee 
Premium After 
$60 Incentive
Employee
         804.98 
         718.18 
          86.80 
          26.80 
Employee + Spouse
      1,571.72 
      1,394.06 
         177.66 
        117.66 
Employee + Child(ren)
      1,290.02 
      1,151.06 
         138.96 
          78.96 
Health 
Maintenance 
Organization 
(HMO)
Employee + Family
      2,057.52 
      1,809.96 
         247.56 
        187.56 
Employee
         842.86 
         729.14 
         113.72 
          53.72 
Employee + Spouse
      1,648.58 
      1,387.60 
         260.98 
        200.98 
Employee + Child(ren)
      1,352.58 
      1,138.06 
         214.52 
        154.52 
Preferred 
Provider 
Organization 
(PPO)
Employee + Family
      2,159.14 
      1,791.86 
         367.28 
        307.28 
Employee
         786.46 
         717.44 
          69.02 
            9.02 
Employee + Spouse
      1,534.12 
      1,439.02 
          95.10 
          35.10 
Employee + Child(ren)
      1,259.44 
      1,176.10 
          83.34 
          23.34 
High 
Deductible 
Health Plan w/ 
HSA - Cigna
(HDHP)
Employee + Family
      2,007.86 
      1,877.78 
         130.08 
          70.08 
Employee
         786.46 
         717.44 
          69.02 
            9.02 
Employee + Spouse
      1,534.12 
      1,439.02 
          95.10 
          35.10 
Employee + Child(ren)
      1,259.44 
      1,176.10 
          83.34 
          23.34 
High 
Deductible 
Health Plan w/ 
HSA - UHG
(HDHP)
Employee + Family
      2,007.86 
      1,877.78 
         130.08 
          70.08 
  Part-Time Active Employees
Plan
 Tier
 Monthly Total 
Premium
 Monthly 
Employer 
Premium 
 Monthly 
Employee 
Premium 
 Monthly 
Employee 
Premium After 
$60 Incentive
Employee
         804.98 
         359.10 
         445.88 
        385.88 
Employee + Spouse
      1,571.72 
         697.04 
         874.68 
        814.68 
Employee + Child(ren)
      1,290.02 
         575.54 
         714.48 
        654.48 
Health 
Maintenance 
Organization 
(HMO)
Employee + Family
      2,057.52 
         904.98 
      1,152.54 
      1,092.54 
Employee
         842.86 
         364.58 
         478.28 
        418.28 
Employee + Spouse
      1,648.58 
         693.80 
         954.78 
        894.78 
Employee + Child(ren)
      1,352.58 
         569.04 
         783.54 
        723.54 
Preferred 
Provider 
Organization 
(PPO)
Employee + Family
      2,159.14 
         895.92 
      1,263.22 
      1,203.22 
Employee
         786.46 
         358.72 
         427.74 
        367.74 
Employee + Spouse
      1,534.12 
         719.52 
         814.60 
        754.60 
Employee + Child(ren)
      1,259.44 
         588.06 
         671.38 
        611.38 
High 
Deductible 
Health Plan w/ 
HSA - Cigna
(HDHP)
Employee + Family
      2,007.86 
         938.90 
      1,068.96 
      1,008.96 
Employee
         786.46 
         358.72 
         427.74 
        367.74 
Employee + Spouse
      1,534.12 
         719.52 
         814.60 
        754.60 
Employee + Child(ren)
      1,259.44 
         588.06 
         671.38 
        611.38 
High 
Deductible 
Health Plan w/ 
HSA - UHG
(HDHP)
Employee + Family
      2,007.86 
         938.90 
      1,068.96 
      1,008.96