Okaloosa County BOCC — July 2, 2013 — Ratesheet — reading text

BENEFIT PROGRAM MONTHLY COST EFFECTIVE 10/01/13~ 9/30/14 Proposed Rates Board of County Commissioners/Supervisor of Elections Base Plan BLUE OPTIONS PPO Plan 3769 DRUG CARD $15 - $50 - $80 Co-pay FULL-TIME Single $725.01 Paid by BCC / SOE EMPLOYEE Family $381.60 Paid by Employee ($190.80 Per Pay Period) COBRA Single $739.51 Paid by Individual Family $1128.74 Paid by Individual RETIREES Single $725.01 Paid by Individual Family $1,106.61 Paid by Individual Buy Up Plan BLUE OPTIONS PPO Plan 3559 DRUG CARD $15 - $50 - $80 Co-pay FULL-TIME Single $725.01 Paid by BCC / SOE Employee Contribution Single $ 49.84 Paid by Employee ($ 24.92 per payday) EMPLOYEE Family $407.81 Paid by Employee ($203.91 Per Pay Period) $228.83 Total per payday COBRA Single $790.35 Paid by Individual Family $1206.31 Paid by Individual RETIREES Single $774.85 Paid by Individual Family $1182.66 Paid by Individual OPTION #3 BLUE OPTIONS PLAN 3361 HRA DRUG CARD $15 - $50 - $80 Co-pay FULL-TIME Single $661.30 Paid by BCC / SOE EMPLOYEE Family $348.03 Paid by Employee ($174.02 Per Pay Period) COBRA Single $674.53 Paid by Individual Family $1029.52 Paid by Individual RETIREES Single $661.30 Paid by Individual Family $1,009.33 Paid by Individual TRICARE SUPPLEMENT FULL-TIME Single $ 67.50 Paid by Employee EMPLOYEE +#one $132.50 Paid by Employee EMPLOYEE Family $178.50 Paid by Employee DENTAL FULL-TIME Single $24.25 Paid by BCC / SOE EMPLOYEE Family $46.08 Paid by Individual ($23.04 Per Pay Period) COBRA Single $24.74 Paid by Individual Family $71.74 Paid by Individual RETIREES Single $24.25 Paid by Individual Family $70.33 Paid by Individual Optional Vision Program Monthly Rates per Payday (24) Employee $ 7.48 $ 3.74 Employee + Spouse 16.12 8.06 Employee + Children 13.00 6.50 Family 21.64 10.82 LONG TERM DISABILITY LONG TERM DISABILITY Basic $4.62 Paid by BCC / SOE Buy Up to 60% $3.36 Paid by Employee (1.68 Per Pay Period) RM2012 Benefits,Benefits monthlyCost 2012 /2013 LIFE Basic Life and AD&D $4.61 Paid by BCC / SOE ($25,000) Supplemental Life may be purchased in increments of $25,000 up to $500,000. Supplemental Life premium is based on age of employee. Le ee ee 4 AGE COST PER. $1,000 ' 7 Under 30 ‘07 i AD & D is available at additional cost of .02 per thousand for employees i i 30-34 .08 i Dependent Life i 1 : . 35-39 1 Employees are eligible to purchase dependent life and spouse life as | follows: 40-44 16 45-49 29 ; Spouse 50% of optional life up to 150,000. 1 Children 50% of optional life up to 10,000. 50-54 A5 ; i 55-59 61 ; 60-64 1.02 ; I 65-69 1.59 ; t 70-74 2.57 1 { 75-79 5.12 ; FLEXIBLE SPENDING Flexible Spending $5.50 Paid by BCC / SOE RM2012 Benefits,Benefits monthlyCost 2012 /2013