CIVIL SERVICE COMMISSION EMPLOYEE BENEFITS DIVISION
FY 2016-2017 GROUP INSURANCE PREMIUM RATES EFFECTIVE OCTOBER 9, 2016 For NERE & Bargaining Units: AFSCME, MCO, MSEA, UAW, SEIU Local 517M, Judicial Branch, and Non-Represented (Z60-Z89) PLAN NAME/CODE [HAEX] State Health Plan PPO
Employee or Spouse with Medicare (State Pays 100%)
[H2F0] Catastrophic Health Plan 2
[H3ZN] Decline Health Ins. [H4ZN] "Opt Out" Health 3 [VBW0] State Vision Plan
[V3ZN] Decline Vision Ins. [DBEX] State Dental Plan
Option Employee Only Employee & Spouse Employee & Child (ren) Full Family Employee Only Employee & Spouse Employee & Child (ren) Full Family
Employee $ 62.74 $ 125.48 $ 110.42 $ 173.16 $ $ $ $ -
BIWEEKLY State $ 250.94 $ 501.91 $ 441.68 $ 692.63 $ 250.94 $ 501.91 $ 441.68 $ 692.63
$ $ $ $ $ $ $ $
Employee Only Employee & Spouse Employee & Child (ren) Full Family (n/a)
$ $ $ $
$ $ $ $
$ $ $ $
(n/a) Employee Only Employee & Spouse Employee & Child (ren) Full Family (n/a) Employee Only Employee & Spouse Employee & Child (ren) Full Family
(n/a) (n/a)
$ $ $ $ $ $ $ $
(n/a) 1.05 1.91 2.32 3.18
15.81 31.62 31.62 31.62 (n/a)
$ $ $ $
(n/a) 2.38 4.19 5.12 6.93 (n/a) 19.87 36.26 44.16 60.49
$ $ $ $
Total 313.68 627.39 552.10 865.79 250.94 501.91 441.68 692.63
Employee $ 1,631.14 $ 3,262.40 $ 2,870.90 $ 4,502.10 $ $ $ $ -
$ $ $ $ $ $ $ $
15.81 31.62 31.62 31.62 (n/a)
$ $ $ $
$ $ $ $
$ $ $ $
(n/a) 2.38 4.19 5.12 6.93 (n/a) 20.92 38.17 46.48 63.67
$ $ $ $
(n/a) (n/a)
$ $ $ $ $ $ $ $
(n/a) 27.19 49.62 60.43 82.77
ANNUAL State 6,524.54 13,049.61 11,483.59 18,008.40 6,524.54 13,049.61 11,483.59 18,008.40 411.06 822.12 822.12 822.12 (n/a)
$ $ $ $
(n/a) 61.97 108.88 132.99 180.23 (n/a) 516.53 942.74 1,148.10 1,572.63
$ $ $ $
$ $ $ $ $ $ $ $ $ $ $ $
Total 8,155.68 16,312.01 14,354.49 22,510.50 6,524.54 13,049.61 11,483.59 18,008.40 411.06 822.12 822.12 822.12 (n/a)
$ $ $ $
(n/a) 61.97 108.88 132.99 180.23 (n/a) 543.72 992.36 1,208.53 1,655.40
$ $ $ $
BIWEEKLY - PART TIME 1 Employee State $ 156.84 $ 156.84 $ 313.69 $ 313.69 $ 276.05 $ 276.05 $ 432.89 $ 432.89 $ $ $ $ $ $ $ $ -
ANNUAL - PART TIME 1 Employee State $ 4,077.84 $ 4,077.84 $ 8,156.00 $ 8,156.01 $ 7,177.24 $ 7,177.25 $ 11,255.25 $ 11,255.25 $ $ $ $ $ $ $ $ -
MONTHLY Leave/LO COBRA $ 679.64 $ 693.23 $ 1,359.33 $ 1,386.52 $ 1,196.21 $ 1,220.13 $ 1,875.88 $ 1,913.39 $ 543.71 $ 554.59 $ 1,087.47 $ 1,109.22 $ 956.97 $ 976.11 $ 1,500.70 $ 1,530.71
$ $ $ $
$ $ $ $
$ $ $ $
-
$ $ $ $
(n/a) (n/a)
7.91 15.81 15.81 15.81 (n/a)
$ $ $ $
1.19 2.09 2.56 3.47
$ $ $ $
$ $ $ $
(n/a) 10.46 19.08 23.24 31.83
$ $ $ $
(n/a) 1.19 2.09 2.56 3.47 (n/a) 10.46 19.08 23.24 31.83
-
$ $ $ $
(n/a)
$ $ $ $
(n/a) 30.98 54.44 66.49 90.11 (n/a) 271.86 496.18 604.26 827.70
$ $ $ $
205.53 411.06 411.06 411.06 (n/a)
$ $ $ $
(n/a) 30.99 54.44 66.50 90.12 (n/a) 271.86 496.18 604.27 827.70
$ $ $ $
34.26 68.51 68.51 68.51 (n/a)
$ $ $ $
34.94 69.88 69.88 69.88 (n/a)
$ $ $ $
(n/a) 5.16 9.07 11.08 15.02 (n/a) 45.31 82.70 100.71 137.95
$ $ $ $
(n/a) 5.27 9.26 11.30 15.32 (n/a) 46.22 84.35 102.73 140.71
$ $ $ $
$ $ $ $
[DP00] Preventive Dental Plan
Employee Only Employee & Spouse Employee & Child (ren) Full Family
$ $ $ $
-
$ $ $ $
2.99 5.21 5.21 7.42
$ $ $ $
2.99 5.21 5.21 7.42
$ $ $ $
-
$ $ $ $
77.74 135.46 135.46 192.92
$ $ $ $
77.74 135.46 135.46 192.92
$ $ $ $
1.50 2.61 2.61 3.71
$ $ $ $
1.50 2.61 2.61 3.71
$ $ $ $
38.87 67.73 67.73 96.46
$ $ $ $
38.87 67.73 67.73 96.46
$ $ $ $
6.48 11.29 11.29 16.08
$ $ $ $
6.61 11.51 11.51 16.40
[DMEX] Midwestern Dental (DMO)
Employee Only Employee & Spouse Employee & Child (ren) Full Family
$ $ $ $
-
$ $ $ $
16.79 16.79 16.79 16.79
$ $ $ $
16.79 16.79 16.79 16.79
$ $ $ $
-
$ $ $ $
436.44 436.44 436.44 436.44
$ $ $ $
436.44 436.44 436.44 436.44
$ $ $ $
8.39 8.39 8.39 8.39
$ $ $ $
8.39 8.39 8.39 8.39
$ $ $ $
218.22 218.22 218.22 218.22
$ $ $ $
218.22 218.22 218.22 218.22
$ $ $ $
36.37 36.37 36.37 36.37
$ $ $ $
37.10 37.10 37.10 37.10
[D3ZN] Decline Dental Ins. [D4ZN] "Opt Out" Dental 4 Employee Life [LUEX/LREX] Employee Life Only (Fire/Crash Rescue Officers--51-01 only) [DL01] Dependent Life Options
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
(n/a)
Employee Only $
Employee Only Sp $ 1,500 &/or Ch $ 1,000 Sp $ 5,000 &/or Ch $ 2,500 Sp $10,000 &/or Ch $ 5,000 Sp $25,000 &/or Ch $10,000 Child(ren) Only $10,000 Sp $50,000 &/or Ch $15,000 Sp $0 &/or Ch $15,000
$ $ $ $ $ $ $ $
-
0.20 0.60 1.20 4.00 0.75 5.26 1.13
24¢/$1,000
24¢/$1,000
$
-
$6.24/$1,000
$6.24/$1,000
$
26¢/$1,000 $ $ $ $ $ $ $ -
26¢/$1,000 $ 0.20 $ 0.60 $ 1.20 $ 4.00 $ 0.75 $ 5.26 $ 1.13
$ $ $ $ $ $ $ $
-
$6.76/$1,000 $ $ $ $ $ $ $ -
$6.76/$1,000 $ 5.20 $ 15.60 $ 31.20 $ 104.00 $ 19.50 $ 136.76 $ 29.38
$ $ $ $ $ $ $ $
5.20 15.60 31.20 104.00 19.50 136.76 29.38
Page 1 of 2
-
0.20 0.60 1.20 4.00 0.75 5.26 1.13
$
-
$
$ $ $ $ $ $ $ $
-
$ $ $ $ $ $ $ $
(n/a) (n/a)
-
24¢/$1,000
52¢/$1,000
$
-
5.20 15.60 31.20 104.00 19.50 136.76 29.38
26¢/$1,000 $ $ $ $ $ $ $ -
56¢/$1,000 $ 0.43 $ 1.30 $ 2.60 $ 8.67 $ 1.63 $ 11.40 $ 2.45
$ $ $ $ $ $ $ $
-
-
CIVIL SERVICE COMMISSION EMPLOYEE BENEFITS DIVISION
FY 2016-2017 GROUP INSURANCE PREMIUM RATES EFFECTIVE OCTOBER 9, 2016 For NERE & Bargaining Units: AFSCME, MCO, MSEA, UAW, SEIU Local 517M, Judicial Branch, and Non-Represented (Z60-Z89) PLAN NAME/CODE [HBCN] Blue Care Network
[HI00] Health Alliance Plan
[HMCL] McLaren Health Plan
[HMEX] Physicians Health Plan
[HPRI] Priority Health Plan
Option Employee Only Employee & Spouse Employee & Child (ren) Full Family Employee Only Employee & Spouse Employee & Child (ren) Full Family Employee Only Employee & Spouse Employee & Child (ren) Full Family Employee Only Employee & Spouse Employee & Child (ren) Full Family Employee Only Employee & Spouse Employee & Child (ren) Full Family
BIWEEKLY State
Employee $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
41.45 82.90 72.95 114.40 40.76 81.87 72.01 113.12 35.70 71.40 62.81 98.52 44.22 88.45 77.83 122.06 58.55 117.07 103.03 161.56
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
234.89 469.78 413.40 648.29 230.98 463.95 408.03 641.00 202.30 404.61 355.95 558.29 250.60 501.20 441.06 691.66 250.94 501.91 441.68 692.63
Total $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
276.34 552.68 486.35 762.69 271.74 545.82 480.04 754.12 238.00 476.01 418.76 656.81 294.82 589.65 518.89 813.72 309.49 618.98 544.71 854.19
ANNUAL State
Employee $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
1,077.71 2,155.45 1,896.79 2,974.52 1,059.79 2,128.70 1,872.14 2,941.06 928.21 1,856.45 1,633.18 2,561.56 1,149.82 2,299.64 2,023.67 3,173.49 1,522.18 3,043.83 2,678.69 4,200.60
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
1
6,107.05 12,214.19 10,748.45 16,855.60 6,005.45 12,062.62 10,608.82 16,665.98 5,259.83 10,519.87 9,254.66 14,515.52 6,515.66 13,031.32 11,467.45 17,983.11 6,524.54 13,049.61 11,483.59 18,008.40
BIWEEKLY - PART TIME 1 Employee State
Total $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
7,184.76 14,369.64 12,645.24 19,830.12 7,065.24 14,191.32 12,480.96 19,607.04 6,188.04 12,376.32 10,887.84 17,077.08 7,665.48 15,330.96 13,491.12 21,156.60 8,046.72 16,093.44 14,162.28 22,209.00
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
138.17 276.34 243.18 381.35 135.87 272.91 240.02 377.06 119.00 238.01 209.38 328.41 147.41 294.83 259.44 406.86 154.74 309.49 272.35 427.10
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
138.17 276.34 243.18 381.35 135.87 272.91 240.02 377.06 119.00 238.01 209.38 328.41 147.41 294.83 259.44 406.86 154.74 309.49 272.35 427.10
ANNUAL - PART TIME 1 Employee State $ 3,592.38 $ 7,184.82 $ 6,322.62 $ 9,915.06 $ 3,532.62 $ 7,095.66 $ 6,240.48 $ 9,803.52 $ 3,094.02 $ 6,188.16 $ 5,443.92 $ 8,538.54 $ 3,832.74 $ 7,665.48 $ 6,745.56 $ 10,578.30 $ 4,023.36 $ 8,046.72 $ 7,081.14 $ 11,104.50
Part-time employees hired on or after 1/1/2000 whose regular work schedule is 40 hours or less per biweekly pay period. Part-time employees hired on or before 12/30/1999 pay the full-time rate. Employees in the Catastrophic Health Plan will receive a $50 rebate with each paycheck beginning the first pay period after effective date of coverage. 3 Employees who opt out of Health coverage (because they have "primary" coverage through a non-State employee or non-State retired spouse) will receive a rebate identical to the Catastrophic Health Plan. 4 Employees who opt out of dental coverage (because they have “primary” coverage through a non-State employee or non-State retired spouse) will receive a rebate identical to the Preventive Dental Plan. 2
Page 2 of 2
$ 3,592.38 $ 7,184.82 $ 6,322.62 $ 9,915.06 $ 3,532.62 $ 7,095.66 $ 6,240.48 $ 9,803.52 $ 3,094.02 $ 6,188.16 $ 5,443.92 $ 8,538.54 $ 3,832.74 $ 7,665.48 $ 6,745.56 $ 10,578.30 $ 4,023.36 $ 8,046.72 $ 7,081.14 $ 11,104.50
MONTHLY Leave/LO COBRA $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
598.73 1,197.47 1,053.77 1,652.51 588.77 1,182.61 1,040.08 1,633.92 515.67 1,031.36 907.32 1,423.09 638.79 1,277.58 1,124.26 1,763.05 670.56 1,341.12 1,180.19 1,850.75
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
610.71 1,221.42 1,074.85 1,685.56 600.55 1,206.26 1,060.88 1,666.60 525.98 1,051.99 925.47 1,451.55 651.57 1,303.13 1,146.75 1,798.31 683.97 1,367.94 1,203.79 1,887.77
