2010-2011 Rates sent to OBAS 61110 (these are the real rates) making PDFs for T01 Retiree

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CIVIL SERVICE COMMISSIONEMPLOYEE BENEFIT DIVISIONFY 2011-2012 GROUP INSURANCE PREMIUM RATESSTATE POLICE RETIREMENT - MONTHLY RATESEFFECTIVE OCTOBER 1, 2011Rates apply to retirees under the State's Defined Benefit Retirement Plan and to thosewho converted from the Defined Benefit Plan to the Defined Contribution plan.Retirees' State Health Plan - Blue Cross Blue Shield PPORetiree State MONTHLY Retiree121-BCBS Share Share TOTAL COBRAG Retiree Only $ 36.72 $ 697.66 $ 734.38 $ 749.07L Retiree & Spouse 73.44 $ 1,395.31 $ 1,468.75 $ 1,498.13R Retiree & Child(ren) $ 46.25 $ 878.80 $ 925.05 $ 943.55W Retiree, Spouse & Child(ren)85.01 $ 1,615.24 $ 1,700.25 $ 1,734.26H Retiree 65+ Only $ - $ 385.05 $ 385.05 $ 392.75M Retiree 65+ & Spouse 65+ - 770.12 770.12 785.52S Retiree 65+ & Child(ren) $ - $ 575.74 $ 575.74 $ 587.25X Retiree 65+ & Spouse 65+ & Child(ren) - $ 1,001.65 $ 1,001.65 $ 1,021.68N Retiree under 65 & Spouse 65+ $ - $ 1,119.43 $ 1,119.43 $ 1,141.82P Retiree 65+ & Spouse under 65 - $ $ $ Y Retiree under 65, Spouse 65+ & Child(ren) $ - $ 1,350.95 $ 1,350.95 $ 1,377.97Z Retiree 65+, Spouse under 65 & Child(ren) - $ $ $ Sponsored Dependent under 65 $ 809.13 $ - $ ...

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• Publié par: Shuit
• Nombre de lectures: 59
• Langue: English

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CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011

Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.

Retirees' State Health Plan  Blue Cross Blue Shield PPO

121BCBS G RetireeOnly L Retiree& Spouse R Retiree& Child(ren) W Retiree,Spouse & Child(ren) H Retiree65+ Only M Retiree65+ & Spouse 65+ S Retiree65+ & Child(ren) X Retiree65+ & Spouse 65+ & Child(ren) N Retireeunder 65 & Spouse 65+ P Retiree65+ & Spouse under 65 Y Retireeunder 65, Spouse 65+ & Child(ren) Z Retiree65+, Spouse under 65 & Child(ren)

Sponsored Dependent under 65 Sponsored Dependent 65+

DDR E RetireeOnly S Retiree& Spouse C Retiree& Child(ren) F Retiree,Spouse & Child(ren)

VBR E RetireeOnly S Retiree& Spouse C Retiree& Child(ren) F Retiree,Spouse & Child(ren)

Retiree Share $ 36.72 $ 73.44 $ 46.25 $ 85.01 $  $  $  $  $  $  $  $ 

$ 809.13 $ 383.01

State Share $ 697.66 $ 1,395.31 $ 878.80 $ 1,615.24 $ 385.05 $ 770.12 $ 575.74 $ 1,001.65 $ 1,119.43 $ 1,119.43 $ 1,350.95 $ 1,350.95

$  $ 

Retirees' State Dental Plan

Retiree Share $ 4.37 $ 7.95 $ 9.72 $ 13.31

State Share $ 39.28 $ 71.59 $ 87.44 $ 119.75

Retirees' State Vision Plan

Retiree Share $ 0.64 $ 1.05 $ 1.45 $ 1.86

State Share $ 5.73 $ 9.32 $ 13.04 $ 16.62

MONTHL TOTAL $ 734.38 $ 1,468.75 $ 925.05 $ 1,700.25 $ 385.05 $ 770.12 $ 575.74 $ 1,001.65 $ 1,119.43 $ 1,119.43 $ 1,350.95 $ 1,350.95

$ 809.13 $ 383.01

MONTHLY TOTAL $ 43.65 $ 79.54 $ 97.16 $ 133.06

MONTHLY TOTAL $ 6.37 $ 10.36 $ 14.49 $ 18.48

Retiree COBR $ 749.07 $ 1,498.13 $ 943.55 $ 1,734.26 $ 392.75 $ 785.52 $ 587.25 $ 1,021.68 $ 1,141.82 $ 1,141.82 $ 1,377.97 $ 1,377.97

$ 825.31 $ 390.67

Retiree COBR $ 44.52 $ 81.13 $ 99.10 $ 135.72

Retiree COBR $ 6.50 $ 10.57 $ 14.78 $ 18.85

CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011

Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.

Blue Care Network MidMichigan

Retiree StateMONTHLY 171 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $491.64 $697.66 $1,189.30 L Retiree& Spouse$ 983.28$ 1,395.31$ 2,378.59 R Retiree& Child(ren)$ 619.71$ 878.80$ 1,498.51 W Retiree,Spouse & Child(ren)$ 1,143.93$ 1,615.24$ 2,759.17 Rates for Retirees or Dependents with Medicare. Service Area:Clinton, Eaton, Ingham, and Jackson Counties. H Retiree65+ Only$ 47.93$ 385.05$ 432.98 M Retiree65+ & Spouse 65+$ 95.84$ 770.12$ 865.96 S Retiree65+ & Child(ren)$ 166.45$ 575.74$ 742.19 X Retiree65+ & Spouse 65+ & Child(ren)$ 173.52$ 1,001.65$ 1,175.17 N Retireeunder 65 & Spouse 65+$ 502.85$ 1,119.43$ 1,622.28 P Retiree65+ & Spouse under 65$ 502.85$ 1,119.43$ 1,622.28 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 580.54$ 1,350.95$ 1,931.49 Z Retiree65+, Spouse under 65 & Child(ren)$ 580.54$ 1,350.95$ 1,931.49

Blue Care Network East MichiganFlint

Retiree StateMONTHLY 181 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $390.02 $697.66 $1,087.68 L Retiree& Spouse$ 780.05$ 1,395.31$ 2,175.36 R Retiree& Child(ren)$ 491.68$ 878.80$ 1,370.48 W Retiree,Spouse & Child(ren$ 908.18$ 1,615.24$ 2,523.42 Rates for Retirees or Dependents with Medicare. Service Area:Bay, Genesee, Gratiot, Lapeer, Midland, Shiawassee, and Tuscola Counties. H Retiree65+ Only$ 65.46$ 385.05$ 450.51 M Retiree65+ & Spouse 65+$ 130.90$ 770.12$ 901.02 S Retiree65+ & Child(ren)$ 157.57$ 575.74$ 733.31 X Retiree65+ & Spouse 65+ & Child(ren)$ 182.17$ 1,001.65$ 1,183.82 N Retireeunder 65 & Spouse 65+$ 418.76$ 1,119.43$ 1,538.19 P Retiree65+ & Spouse under 65$ 418.76$ 1,119.43$ 1,538.19 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 470.04$ 1,350.95$ 1,820.99 Z Retiree65+, Spouse under 65 & Child(ren)$ 470.04$ 1,350.95$ 1,820.99

Retiree COBRA

$ 1,213.09 $ 2,426.16 $ 1,528.48 $ 2,814.35

$ 441.64 $ 883.28 $ 757.03 $ 1,198.67 $ 1,654.73 $ 1,654.73 $ 1,970.12 $ 1,970.12

Retiree COBRA

$ 1,109.43 $ 2,218.87 $ 1,397.89 $ 2,573.89

$ 459.52 $ 919.04 $ 747.98 $ 1,207.50 $ 1,568.95 $ 1,568.95 $ 1,857.41 $ 1,857.41

CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011

Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.

Blue Care Network East MichiganSaginaw

Retiree StateMONTHLY 191 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $298.42 $697.66 $996.08 L Retiree& Spouse$ 596.85$ 1,395.31$ 1,992.16 R Retiree& Child(ren)$ 376.26$ 878.80$ 1,255.06 W Retiree,Spouse & Child(ren$ 695.67$ 1,615.24$ 2,310.91 Rates for Retirees or Dependents with Medicare. Service Area:Saginaw County. H Retiree65+ Only$ 65.46$ 385.05$ 450.51 M Retiree65+ & Spouse 65+$ 130.90$ 770.12$ 901.02 S Retiree65+ & Child(ren)$ 133.75$ 575.74$ 709.49 X Retiree65+ & Spouse 65+ & Child(ren)$ 158.35$ 1,001.65$ 1,160.00 N Retireeunder 65 & Spouse 65+$ 327.16$ 1,119.43$ 1,446.59 P Retiree65+ & Spouse under 65$ 327.16$ 1,119.43$ 1,446.59 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 354.62$ 1,350.95$ 1,705.57 Z Retiree65+, Spouse under 65 & Child(ren)$ 354.62$ 1,350.95$ 1,705.57

Blue Care Network Southeast Michigan

Retiree COBRA

$ 1,016.00 $ 2,032.00 $ 1,280.16 $ 2,357.13

$ 459.52 $ 919.04 $ 723.68 $ 1,183.20 $ 1,475.52 $ 1,475.52 $ 1,739.68 $ 1,739.68

Retiree StateMONTHLY Retiree 211 ShareShare TOTALCOBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $468.14 $697.66 $1,165.80 $1,189.12 L Retiree& Spouse$ 936.28$ 1,395.31$ 2,331.59$ 2,378.22 R Retiree& Child(ren)$ 590.10$ 878.80$ 1,468.90$ 1,498.28 W Retiree,Spouse & Child(ren$ 1,089.41$ 1,615.24$ 2,704.65$ 2,758.74 Rates for Retirees or Dependents with Medicare. Service Area:Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw, and Wayne Counties. H Retiree65+ Only$ 101.30$ 385.05$ 486.35$ 496.08 M Retiree65+ & Spouse 65+$ 195.70$ 770.12$ 972.70$ 992.15 S Retiree65+ & Child(ren)$ 187.90$ 575.74$ 789.45$ 805.24 X Retiree65+ & Spouse 65+ & Child(ren)$ 244.90$ 1,001.65$ 1,275.80$ 1,301.32 N Retireeunder 65 & Spouse 65+$ 443.25$ 1,119.43$ 1,652.15$ 1,685.19 P Retiree65+ & Spouse under 65$ 443.25$ 1,119.43$ 1,652.15$ 1,685.19 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 492.46$ 1,350.95$ 1,955.25$ 1,994.36 Z Retiree65+, Spouse under 65 & Child(ren)$ 492.46$ 1,350.95$ 1,955.25$ 1,994.36

CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011

Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.

Blue Care Network West MichiganGreat Lakes

Retiree StateMONTHLY Retiree 311 ShareShare TOTALCOBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $359.92 $697.66 $1,057.58 $1,078.73 L Retiree& Spouse$ 719.84$ 1,395.31$ 2,115.15$ 2,157.45 R Retiree& Child(ren)$ 453.75$ 878.80$ 1,332.55$ 1,359.20 W Retiree,Spouse & Child(ren$ 838.33$ 1,615.24$ 2,453.57$ 2,502.64 Rates for Retirees or Dependents with Medicare. Service Area:Allegan, Barry, Calhoun, Ionia, Kalamazoo, Kent, Montcalm, Muskegon, Newaygo, and Ottawa Counties. H Retiree65+ Only$ 22.03$ 385.05$ 407.08$ 415.22 M Retiree65+ & Spouse 65+$ 44.04$ 770.12$ 814.16$ 830.44 S Retiree65+ & Child(ren)$ 106.31$ 575.74$ 682.05$ 695.69 X Retiree65+ & Spouse 65+ & Child(ren)$ 87.48$ 1,001.65$ 1,089.13$ 1,110.91 N Retireeunder 65 & Spouse 65+$ 345.23$ 1,119.43$ 1,464.66$ 1,493.95 P Retiree65+ & Spouse under 65$ 345.23$ 1,119.43$ 1,464.66$ 1,493.95 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 388.68$ 1,350.95$ 1,739.63$ 1,774.42 Z Retiree65+, Spouse under 65 & Child(ren)$ 388.68$ 1,350.95$ 1,739.63$ 1,774.42

Health Alliance Plan

Retiree StateMONTHLY 201 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $240.87 $697.66 $938.53 L Retiree& Spouse$ 481.75$ 1,395.31$ 1,877.06 R Retiree& Child(ren)$ 303.77$ 878.80$ 1,182.57 W Retiree,Spouse & Child(ren$ 562.15$ 1,615.24$ 2,177.39 Rates for Retirees or Dependents with Medicare. Service Area:Genesee, Lapeer, Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw, and Wayne Counties. H Retiree65+ Only$ 5.25$ 385.05$ 390.30 M Retiree65+ & Spouse 65+$ 10.48$ 770.12$ 780.60 S Retiree65+ & Child(ren)$ 58.60$ 575.74$ 634.34 X Retiree65+ & Spouse 65+ & Child(ren)$ 79.28$ 1,001.65$ 1,080.93 N Retireeunder 65 & Spouse 65+$ 209.40$ 1,119.43$ 1,328.83 P Retiree65+ & Spouse under 65$ 209.40$ 1,119.43$ 1,328.83 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 278.21$ 1,350.95$ 1,629.16 Z Retiree65+, Spouse under 65 & Child(ren)$ 278.21$ 1,350.95$ 1,629.16

Retiree COBRA

$ 957.30 $ 1,914.60 $ 1,206.22 $ 2,220.94

$ 398.11 $ 796.21 $ 647.03 $ 1,102.55 $ 1,355.41 $ 1,355.41 $ 1,661.74 $ 1,661.74

CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011

Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.

HealthPlus Retiree StateMONTHLY 622 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $387.46 $697.66 $1,085.12 L Retiree& Spouse$ 774.93$ 1,395.31$ 2,170.24 R Retiree& Child(ren)$ 488.45$ 878.80$ 1,367.25 W Retiree,Spouse & Child(ren$ 902.24$ 1,615.24$ 2,517.48 Rates for Retirees or Dependents with Medicare. Service Area:Arenac, Bay, Genesee, Lapeer, Oakland, Saginaw, Shiawassee, St. Clair and Tuscola Counties. H Retiree65+ Only$ 25.60$ 385.05$ 410.65 M Retiree65+ & Spouse 65+$ 51.18$ 770.12$ 821.30 S Retiree65+ & Child(ren)$ 328.80$ 575.74$ 904.54 X Retiree65+ & Spouse 65+ & Child(ren)$ 313.54$ 1,001.65$ 1,315.19 N Retireeunder 65 & Spouse 65+$ 376.35$ 1,119.43$ 1,495.78 P Retiree65+ & Spouse under 65$ 376.35$ 1,119.43$ 1,495.78 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 354.98$ 1,350.95$ 1,705.93 Z Retiree65+, Spouse under 65 & Child(ren)$ 354.98$ 1,350.95$ 1,705.93

PHP Lansing

Retiree COBRA

$ 1,106.82 $ 2,213.64 $ 1,394.60 $ 2,567.83

$ 418.86 $ 837.73 $ 922.63 $ 1,341.49 $ 1,525.70 $ 1,525.70 $ 1,740.05 $ 1,740.05

Retiree StateMONTHLY Retiree 878 ShareShare TOTALCOBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility.This HMO is not available to retirees who are Medicare eligible or to retirees with Medicareeligible dependents. G RetireeOnly $294.24 $697.66 $991.90 $1,011.73 L Retiree& Spouse$ 588.47$ 1,395.31$ 1,983.78$ 2,023.46 R Retiree& Child(ren)$ 370.60$ 878.80$ 1,249.40$ 1,274.39 W Retiree,Spouse & Child(ren$ 681.29$ 1,615.24$ 2,296.53$ 2,342.46

CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011

Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.

Priority West

Retiree StateMONTHLY 555 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $339.78 $697.66 $1,037.44 L Retiree& Spouse$ 677.45$ 1,395.31$ 2,072.76 R Retiree& Child(ren)$ 427.01$ 878.80$ 1,305.81 W Retiree,Spouse & Child(ren$ 789.14$ 1,615.24$ 2,404.38 Rates for Retirees or Dependents with Medicare. Service Area:Allegan, Antrim, Benzie, Crawford, Grand Traverse, Kalkaska, Kent, Leenanau, Manistee, Montcalm, Muskegon, Oceana, Osceola, and Ottawa Counties. H Retiree65+ Only$ 242.32$ 385.05$ 627.37 M Retiree65+ & Spouse 65+$ 484.62$ 770.12$ 1,254.74 S Retiree65+ & Child(ren)$ 537.42$ 575.74$ 1,113.16 X Retiree65+ & Spouse 65+ & Child(ren)$ 738.88$ 1,001.65$ 1,740.53 N Retireeunder 65 & Spouse 65+$ 257.53$ 1,119.43$ 1,376.96 P Retiree65+ & Spouse under 65$ 257.53$ 1,119.43$ 1,376.96 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 511.80$ 1,350.95$ 1,862.75 Z Retiree65+, Spouse under 65 & Child(ren)$ 511.80$ 1,350.95$ 1,862.75

Priority East

Retiree COBRA

$ 1,058.19 $ 2,114.22 $ 1,331.93 $ 2,452.47

$ 639.92 $ 1,279.83 $ 1,135.42 $ 1,775.34 $ 1,404.50 $ 1,404.50 $ 1,900.01 $ 1,900.01

Retiree StateMONTHLY Retiree Share ShareTOTAL COBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility.This HMO is not available to retirees who are Medicare eligible or to retirees with Medicareeligible dependents. G RetireeOnly $339.78 $697.66 $1,037.44 $1,058.19 L Retiree& Spouse$ 677.45$ 1,395.31$ 2,072.76$ 2,114.22 R Retiree& Child(ren)$ 427.01$ 878.80$ 1,305.81$ 1,331.93 W Retiree,Spouse & Child(ren$ 789.14$ 1,615.24$ 2,404.38$ 2,452.47

Priority South

Retiree StateMONTHLY Retiree Share ShareTOTAL COBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility.This HMO is not available to retirees who are Medicare eligible or to retirees with Medicareeligible dependents. G RetireeOnly $339.78 $697.66 $1,037.44 $1,058.19 L Retiree& Spouse$ 677.45$ 1,395.31$ 2,072.76$ 2,114.22 R Retiree& Child(ren)$ 427.01$ 878.80$ 1,305.81$ 1,331.93 W Retiree,Spouse & Child(ren$ 789.14$ 1,615.24$ 2,404.38$ 2,452.47