MEDICAL PLAN RATES					DA INSPECTORS
FOR CALENDAR YEAR 2009
Effective:	January 1, 2009 through December 31, 2009
				EE MONTHLY COSTS				EE
	Plan	Monthly	County	EE	EE	Total		PAY PERIOD
	Code	Premium	Contribution	Cost	Cost	EE		COST
				For Plan	Admin	Cost
					0.45% of premium
BLUE SHIELD ACCESS (EXT) HMO
EE	3011	560.57	532.54	28.03	2.52	30.55		15.28
EE +1	3012	1,121.14	840.86	280.28	5.05	285.33		142.66
EE +2	3013	1,457.48	1,093.11	364.37	6.56	370.93		185.46
BLUE SHIELD HPN HMO  (Not currently available in Santa Cruz County)
EE	0601	495.50	495.50	0.00	2.23	2.23		1.11
EE +1	0602	991.00	840.86	150.14	4.46	154.60		77.30
EE +2	0603	1,288.30	1,093.11	195.19	5.80	200.99		100.49
KAISER (San Jose & SF Bay Area Residents Only)
EE	3051	508.30	508.30	0.00	2.29	2.29		1.14
EE +1	3052	1,016.60	840.86	175.74	4.57	180.31		90.16
EE +2	3053	1,321.58	1,093.11	228.47	5.95	234.42		117.21
PERSCARE
EE	3251	749.83	532.54	217.29	3.37	220.66		110.33
EE +1	3252	1,499.66	840.86	658.80	6.75	665.55		332.77
EE +2	3253	1,949.56	1,093.11	856.45	8.77	865.22		432.61
PERS CHOICE
EE	3201	482.48	482.48	0.00	2.17	2.17		1.09
EE +1	3202	964.96	840.86	124.10	4.34	128.44		64.22
EE +2	3203	1,254.45	1,093.11	161.34	5.65	166.99		83.49
PERS SELECT (Check Provider Directory)
EE	0721	453.16	453.16	0.00	2.04	2.04		1.02
EE +1	0722	906.32	840.86	65.46	4.08	69.54		34.77
EE +2	0723	1,178.22	1,093.11	85.11	5.30	90.41		45.21
PORAC (Available only to PORAC Assn members which may include Probation Employees)
EE	2071	484.00	484.00	0.00	2.18	2.18		1.09
EE +1	2072	906.00	840.86	65.14	4.08	69.22		34.61
EE +2	2073	1,151.00	1,093.11	57.89	5.18	63.07		31.53
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
1 OR MORE DEPENDENTS
ONE FULL YEAR OF ENROLLMENT REQUIRED						18.01		9.01
			MAXIMUM MONTHLY COUNTY  CONTRIBUTION
				ACTIVE		RETIREE
EE = employee only				532.64		408.94
EE+1 = employee plus one dependent				840.86		489.01
EE+2 = employee plus two or more dependents				1,093.11		569.62