 |
|
|
|
Premium Rates Effective July 1, 2010 - June 30, 2011
Active Participants (charge to your dollar bank):
| |
IBEW PPO |
Group
Health |
|
|
Medical |
$ |
748.15 |
$ |
1,004.95 |
|
|
Dental |
|
113.74 |
|
113.74 |
|
|
Vision |
|
9.08 |
|
9.08 |
|
|
Weekly Disability ($250/wk)*** |
|
4.95 |
|
4.95 |
|
|
Life/AD&D |
|
3.25 |
|
3.25 |
|
|
Total Monthly Premium |
$ |
879.17 |
$ |
1,135.97 |
|
|
Less Trust Subsidy |
|
(6.50) |
|
(6.50) |
|
|
Monthly Charge to Your Dollar Bank |
$ |
872.67 |
$ |
1,129.47 |
|
*** 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, from
$4.95 to
$23.95 per month.
|
Monthly charge to Your Dollar Bank for
Participants who elect the Supplemental Weekly Time Loss
Disability coverage. |
$ |
891.67 |
$ |
1,148.47 |
|
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, 2010 - June 30, 2011:
[Top of Page]
| |
IBEW PPO |
Group
Health HMO |
|
|
Medical, Dental, Vision & Life |
$ |
899.22 |
$ |
1,156.02 |
|
|
Medical Only |
|
773.15 |
|
1,029.95 |
|
Retiree Rates Effective July
1, 2010 - June 30, 2011:
[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 Age 65 and Older |
$ |
620.50 |
$ |
416.22 |
|
|
Two Under 65 |
|
1,040.38 |
|
1,300.86 |
|
|
One 65 or Older / One Under 65 |
|
830.44 |
|
858.54 |
|
|
One Age 65 and Older |
|
310.25 |
|
208.11 |
|
|
One Under 65 |
|
520.19 |
|
650.43 |
|
|
Each non-spouse dependent |
221.68 |
189.78 |
|
|
|
(2nd + 166.59) |
|
The retiree rates listed above do not apply to
those participants who qualify for coverage under the IBEW Local 76
Subsidized Retiree Health and Welfare Plan provisions (subsidized
health plan). Please contact the Administrator for additional
information.
Subsidized Retiree Rates Effective July
1, 2010 - June 30, 2011:
[Top of Page]
The following are the co-payment rates for the
subsidized retiree program effective July 1, 2010. The
co-payments are 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 |
$ |
748.15 |
$ |
1,004.95 |
|
|
Dental |
|
113.74 |
|
113.74 |
|
|
Vision |
|
9.08 |
|
9.08 |
|
|
Total Premiums |
$ |
870.97 |
$ |
1,127.77 |
|
|
|
|
Subsidized Retiree Co-Payment |
|
|
|
Participant
20% |
$ |
175.00 |
$ |
226.00 |
|
|
Participant & Spouse
30% |
|
261.50 |
|
338.50 |
|
|
Each Dependant
10% |
|
87.50 |
|
113.00 |
|
| |
|
|
|
|
|
Non-Bargaining Unit Rates Effective July 1, 2010 - June 30, 2011
| |
IBEW PPO |
Group
Health HMO |
|
|
Medical, Dental & Vision |
$ |
870.97 |
$ |
1,127.77 |
|
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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