Medical Contribution Chart
April 8, 2003
Note: The four (4) Tier system referred to in the Medical Contribution Plan is defined by the following categories:
- 1 Adult
- 2 Adult
- 1 Adult & Children
- 2 Adults & Children
Active Employee
Medical (PPO Option)
| 1 Adult | 2 Adults | 1 Adult & Children | 2 Adults & Children | |
|---|---|---|---|---|
| 2003 Rates based on proposed plan design | $252.38 | $529.99 | $479.51 | $757.13 |
| Employee Contribution 10% | $25.24 | $53.00 | $47.95 | $75.71 |
Dental (Traditional Plan)
| 1 Adult | 2 Adults | 1 Adult & Children | 2 Adults & Children | |
|---|---|---|---|---|
| 2003 Rates based on proposed plan design | $33.41 | $70.15 | $73.51 | $110.25 |
| Employee Contribution 10% | $3.34 | $7.02 | $7.35 | $11.03 |
Retiree Employee
Medical (PPO Option)
| 1 Adult | 2 Adults | 1 Adult & Children | 2 Adults & Children | |
|---|---|---|---|---|
| 2003 Rates based on proposed plan design | $252.38 | $529.99 | $479.51 | $757.13 |
| Pre-Medicare Retiree Contribution 40% | $100.95 | $212.00 | $191.80 | $302.85 |
| Pre-Medicare Retiree Contribution 60% | $151.43 | $317.99 | $287.71 | $454.28 |
| Pre-Medicare Retiree Contribution 80% | $201.90 | $423.99 | $383.61 | $605.70 |
