 |
|
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Premium Rates Effective October 1, 2009 - June 30, 2010
Active Participants (charge to your dollar bank):
| |
IBEW PPO |
Group
Health |
|
|
Medical |
$ |
687.50 |
$ |
802.36 |
|
|
Dental |
|
118.95 |
|
118.95 |
|
|
Vision |
|
9.08 |
|
9.08 |
|
|
Weekly Disability ($250/wk)*** |
|
4.95 |
|
4.95 |
|
|
Life/AD&D |
|
3.75 |
|
3.75 |
|
|
Total Monthly Premium |
$ |
824.23 |
$ |
939.09 |
|
|
Less Trust Subsidy |
|
(6.50) |
|
(6.50) |
|
|
Monthly Charge to Your Dollar Bank |
$ |
817.73 |
$ |
932.59 |
|
If
you maintain or select the Supplemental Weekly Time Loss
Disability coverage your benefit becomes $400.00 per week and the
charge to your dollar bank will increase by $19.00 per month to
$23.20 per month, only
for those selecting or maintaining the Supplemental Weekly Time Loss
benefit.
|
Monthly Charge to Your Dollar Bank with Supp. Wkly. Time Loss |
$ |
836.73 |
$ |
951.59 |
|
If you are making COBRA self-payments or
Retiree self-payments be sure to tender the proper amount as
indicated below for your coverage.
[Top of Page]
COBRA Rates Effective July 1, 2009 - June 30, 2010:
[Top of Page]
| |
IBEW PPO |
Group
Health HMO |
|
|
Medical, Dental, Vision & Life |
$ |
844.28 |
$ |
959.14 |
|
|
Medical Only |
|
712.50 |
|
827.36 |
|
Retiree Rates Effective July
1, 2009 - June 30, 2010:
[Top of Page]
(does not apply to participants covered
under the IBEW Local 76 Subsidized Retiree Health and Welfare Trust
Plan)
| |
IBEW PPO |
Group
Health HMO |
|
|
Two Over 65 - (5) |
$ |
620.50 |
$ |
385.42 |
|
|
Two Under 65 - (6) |
|
989.80 |
|
1237.62 |
|
|
One Over / One Under 65 - (4) |
|
805.15 |
|
811.52 |
|
|
One Over 65 - (2) |
|
310.25 |
|
192.71 |
|
|
One Under 65 - (3) |
|
494.90 |
|
618.81 |
|
|
Each non-spouse dependent |
210.91 |
180.56 |
|
|
|
(2nd+158.49) |
|
Subsidized Retiree Rates Effective July
1, 2009 - June 30, 2010:
[Top of Page]
The following are the co-payment rates for the
subsidized retiree program based on the premiums paid for Active
Participants. All co-payment amounts are rounded to the next
highest $0.50 increment.
|
Trust Paid Premium Payments |
IBEW PPO |
Group
Health HMO |
|
|
Medical/Prescription |
$ |
687.50 |
$ |
802.36 |
|
|
Dental |
|
118.95 |
|
118.95 |
|
|
Vision |
|
9.08 |
|
9.08 |
|
|
Total Premiums |
$ |
815.53 |
$ |
930.39 |
|
|
|
|
Subsidized Retiree Co-Payment |
|
|
|
Participant
20% |
$ |
163.50 |
$ |
186.50 |
|
|
Participant & Spouse
30% |
|
245.00 |
|
279.50 |
|
|
Each Dependant
10% |
|
82.00 |
|
93.50 |
|
| |
|
|
|
|
|
Non-Bargaining Unit Rates Effective July 1, 2009 - June 30, 2010
| |
IBEW PPO |
Group
Health HMO |
|
|
Medical, Dental & Vision |
$ |
815.53 |
$ |
930.39 |
|
If you have any questions
concerning premium rates or need information about your coverage
please contact the Administrator at: 800-460-2940
[Top of Page] |
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