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| MIDDLE MANAGEMENT |
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2009 MONTHLY COUNTY
CONTRIBUTIONS |
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| MEDICAL
PLAN RATES & MONTHLY COUNTY CONTRIBUTIONS |
|
|
MEDICAL |
FHA |
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| FOR
CALENDAR YEAR 2009 |
|
|
|
EE |
457.00 |
75.54 |
|
|
|
| Effective: |
January 1, 2009 through
December 31, 2009 |
|
EE + 1 |
507.00 |
445.97 |
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EE + 2 |
563.00 |
675.86 |
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|
MONTHLY COUNTY CONTRIBUTIONS |
EE MONTHLY COSTS |
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|
|
AVAILABLE FOR MEDICAL PREMIUMS |
EE |
EE |
Total |
|
|
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|
TOTAL **1 |
|
Medical |
|
FHA **2 |
Cost |
Cost |
EE |
|
EE |
|
|
Plan |
Monthly |
Contribution |
= |
Contribution |
+ |
Contribution |
For Plan |
Admin |
Cost |
|
PAY PERIOD |
|
|
Code |
Premium |
|
|
|
|
|
.45%
of Premium |
|
COST |
|
| BLUE SHIELD ACCESS (EXT) HMO |
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|
| EE |
3011 |
560.57 |
532.54
|
95% |
457.00 |
|
75.54
|
28.03
|
2.52
|
30.55
|
|
15.28
|
|
| EE +1 |
3012 |
1,121.14 |
952.97
|
85% |
507.00 |
|
445.97
|
168.17
|
5.05
|
173.22
|
|
86.61
|
|
| EE +2 |
3013 |
1,457.48 |
1,238.86
|
85% |
563.00 |
|
675.86
|
218.62
|
6.56
|
225.18
|
|
112.59
|
|
|
|
|
|
|
|
| BLUE
SHIELD HPN HMO (Not currently
available in Santa Cruz County) |
|
|
| EE |
0601 |
495.50 |
495.50 |
|
457.00 |
|
38.50 |
0.00 |
2.23
|
2.23
|
|
1.11
|
|
| EE +1 |
0602 |
991.00 |
952.97
|
|
507.00 |
|
445.97
|
38.03
|
4.46
|
42.49
|
|
21.25
|
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|
| EE +2 |
0603 |
1,288.30 |
1,238.86
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|
563.00 |
|
675.86
|
49.44
|
5.80
|
55.24
|
|
27.62
|
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| KAISER
(San Jose & SF Bay Area Residents Only) |
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|
| EE |
3051 |
508.30 |
508.30 |
|
457.00 |
|
51.30 |
0.00 |
2.29
|
2.29
|
|
1.14 |
|
| EE +1 |
3052 |
1,016.60 |
952.97
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|
507.00 |
|
445.97
|
63.63
|
4.57
|
68.21
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|
34.10 |
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| EE +2 |
3053 |
1,321.58 |
1,238.86
|
|
563.00 |
|
675.86
|
82.72
|
5.95
|
88.67
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|
44.33 |
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| PERSCARE |
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| EE |
3251 |
749.83 |
532.54
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|
457.00 |
|
75.54
|
217.29 |
3.37
|
220.66 |
|
110.33 |
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| EE +1 |
3252 |
1,499.66 |
952.97
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|
507.00 |
|
445.97
|
546.69
|
6.75
|
553.44
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|
276.72
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| EE +2 |
3203 |
1,949.56 |
1,238.86
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|
563.00 |
|
675.86
|
710.70 |
8.77
|
719.48
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|
359.74
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| PERS
CHOICE |
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| EE |
3201 |
482.48 |
482.48 |
|
457.00 |
|
25.48 |
0.00 |
2.17
|
2.17
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|
1.09 |
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| EE +1 |
3202 |
964.96 |
952.97
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|
507.00 |
|
445.97
|
11.99
|
4.34
|
16.33
|
|
8.17 |
|
| EE +2 |
3203 |
1,254.45 |
1,238.86
|
|
563.00 |
|
675.86
|
15.59
|
5.65
|
21.24
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|
10.62 |
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| PERS
SELECT (Check Provider Directory) |
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|
| EE |
0721 |
453.16 |
453.16 |
|
457.00 |
|
0.00 |
0.00 |
2.04
|
2.04
|
|
1.02 |
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| EE +1 |
0722 |
906.32 |
906.32 |
|
507.00 |
|
399.32 |
0.00 |
4.08
|
4.08 |
|
2.04 |
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| EE +2 |
0723 |
1,178.22 |
1,178.22 |
|
563.00 |
|
615.22 |
0.00 |
5.30
|
5.30
|
|
2.65 |
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| PORAC
(Available only to PORAC Assn members which may include Probation
Employees) |
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|
| EE |
2071 |
484.00 |
484.00 |
|
457.00 |
|
27.00 |
0.00 |
2.18
|
2.18
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|
1.09 |
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| EE +1 |
2072 |
906.00 |
906.00 |
|
507.00 |
|
399.00 |
0.00 |
4.08
|
4.08
|
|
2.04 |
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| EE +2 |
2073 |
1,151.00 |
1,151.00 |
|
563.00 |
|
588.00 |
0.00 |
5.18
|
5.18
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|
2.59 |
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| DELTA
PREFERRED OPTION (DPO) PLUS DENTAL COVERAGE |
|
|
| EE+1
OR MORE DEPENDENTS -- ONE FULL YEAR OF ENROLLMENT REQUIRED |
|
48.00 |
|
24.00 |
|
|
|
|
|
|
| VISION
SERVICE PLAN |
|
|
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| 1
OR MORE DEPENDENTS -- ONE FULL YEAR OF ENROLLMENT REQUIRED |
|
|
18.01 |
|
9.01 |
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| EE =
employee only |
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|
MONTHLY COUNTY CONTRIBUTION |
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|
| EE+1 =
employee plus one dependent |
|
RETIREE MEDICAL |
|
|
|
| EE+2 =
employee plus two or more dependents |
|
RETIREE |
|
457.00 |
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|
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|
RETIREE + 1 |
|
507.00 |
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|
RETIREE + 2 |
|
563.00 |
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| **1 |
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| TOTAL
COUNTY CONTRIBUTION FORMULA FOR EE ONLY IS EQUAL TO 95% OF THE BLUE SHIELD
ACCESS (EXT) HMO PREMIUM |
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| TOTAL
COUNTY CONTRIBUTION FORMULA FOR EE+1 IS EQUAL TO 85% OF THE BLUE SHIELD
ACCESS (EXT) HMO PREMIUM |
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| TOTAL
COUNTY CONTRIBUTION FORMULA FOR EE+2 IS EQUAL TO 85% OF THE BLUE SHIELD
ACCESS (EXT) HMO PREMIUM |
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| **2 |
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| FLEXIBLE
HEALTH ALLOWANCE (FHA) CONTRIBUTION IS 95/85/85 OF THE BLUE SHIELD ACCESS
(EXT) HMO PREMIUM, LESS THE |
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| COUNTY
MEDICAL CONTRIBUTION. EMPLOYEES MAY
USE ALL OR PART OF THEIR FHA TO PURCHASE MEDICAL, DPO PLUS |
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| DENTAL
AND/OR VSP DEPENDENT VISION. UNUSED
FHA WILL BE FORFEITED. EMPLOYEES MUST
BE ENROLLED IN A COUNTY |
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| MEDICAL
PLAN TO PARTICIPATE. FHA MAY NOT BE
APPLIED TO CALPERS ADMIN FEE. |
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