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| CORRECTIONAL OFFICERS |
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2009 MONTHLY COUNTY
CONTRIBUTIONS |
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| MEDICAL
PLAN RATES & MONTHLY COUNTY CONTRIBUTIONS |
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MEDICAL |
FHA |
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| FOR
CALENDAR YEAR 2009 |
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|
EE |
428.69 |
103.85 |
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| Effective: |
February 1, 2009 through
December 31, 2009 |
|
EE + 1 |
505.71 |
391.20 |
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EE + 2 |
563.00 |
602.98 |
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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% |
428.69 |
|
103.85
|
28.03
|
2.52
|
30.55
|
|
15.28
|
|
| EE +1 |
3012 |
1,121.14 |
896.91
|
80% |
505.71 |
|
391.20
|
224.23
|
5.05
|
229.27
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|
114.64
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| EE +2 |
3013 |
1,457.48 |
1,165.98
|
80% |
563.00 |
|
602.98
|
291.50
|
6.56
|
298.05
|
|
149.03
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| BLUE
SHIELD HPN HMO (Not currently
available in Santa Cruz County) |
|
|
| EE |
0601 |
495.50 |
495.50 |
|
428.69 |
|
66.81 |
0.00 |
2.23
|
2.23
|
|
1.11
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| EE +1 |
0602 |
991.00 |
896.91 |
|
505.71 |
|
391.20 |
94.09 |
4.46
|
98.55
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|
49.27
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| EE +2 |
0603 |
1,288.30 |
1,165.98 |
|
563.00 |
|
602.98 |
122.32 |
5.80
|
128.12
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|
64.06
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| KAISER
(San Jose & SF Bay Area Residents Only) |
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| EE |
3051 |
508.30 |
508.30 |
|
428.69 |
|
79.61 |
0.00 |
2.29
|
2.29
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|
1.14 |
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| EE +1 |
3052 |
1,016.60 |
896.91 |
|
505.71 |
|
391.20 |
119.69 |
4.57
|
124.26
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|
62.13 |
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| EE +2 |
3053 |
1,321.58 |
1,165.98 |
|
563.00 |
|
602.98 |
155.60 |
5.95
|
161.55
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|
80.77 |
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| PERSCARE |
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| EE |
3251 |
749.83 |
532.54
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|
428.69 |
|
103.85
|
217.29 |
3.37
|
220.66 |
|
110.33 |
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| EE +1 |
3252 |
1,499.66 |
896.91 |
|
505.71 |
|
391.20 |
602.75 |
6.75
|
609.50
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|
304.75
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| EE +2 |
3203 |
1,949.56 |
1,165.98 |
|
563.00 |
|
602.98 |
783.58 |
8.77
|
792.35
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|
396.18
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| PERS
CHOICE |
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| EE |
3201 |
482.48 |
482.48 |
|
428.69 |
|
53.79 |
0.00 |
2.17
|
2.17
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1.09 |
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| EE +1 |
3202 |
964.96 |
896.91 |
|
505.71 |
|
391.20 |
68.05
|
4.34
|
72.39
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|
36.20 |
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| EE +2 |
3203 |
1,254.45 |
1,165.98 |
|
563.00 |
|
602.98 |
88.47 |
5.65
|
94.12
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|
47.06 |
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| PERS
SELECT (Check Provider Directory) |
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|
| EE |
0721 |
453.16 |
453.16 |
|
428.69 |
|
24.47 |
0.00 |
2.04
|
2.04
|
|
1.02 |
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| EE +1 |
0722 |
906.32 |
896.91 |
|
505.71 |
|
391.20 |
9.41
|
4.08
|
13.49
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|
6.74 |
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| EE +2 |
0723 |
1,178.22 |
1,165.98 |
|
563.00 |
|
602.98 |
12.24 |
5.30
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17.54
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|
8.77 |
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| DELTA
PREFERRED OPTION (DPO) PLUS DENTAL COVERAGE |
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| EE+1
OR MORE DEPENDENTS -- ONE FULL YEAR OF ENROLLMENT REQUIRED |
|
48.00 |
|
24.00 |
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| VISION
SERVICE PLAN |
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| 1
OR MORE DEPENDENTS -- ONE FULL YEAR OF ENROLLMENT REQUIRED |
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|
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 |
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| EE+2 =
employee plus two or more dependents |
|
RETIREE |
|
428.69 |
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RETIREE + 1 |
|
505.71 |
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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 80% OF THE BLUE SHIELD
ACCESS (EXT) HMO PREMIUM |
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| TOTAL
COUNTY CONTRIBUTION FORMULA FOR EE+2 IS EQUAL TO 80% OF THE BLUE SHIELD
ACCESS (EXT) HMO PREMIUM |
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| **2 |
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| FLEXIBLE
HEALTH ALLOWANCE (FHA) CONTRIBUTION IS 95/80/80 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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