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i <br /> Proposed 2013 Flexible Benefits Plan Renewal <br /> Sin le +Spouse +Child(ren) Family <br /> 2013 City Contribution 484.00 708.00 708.00 951.00 <br /> Life Ins 4.50 4.50 4.50 4.50 <br /> Single Dental 35.60 35.60 35.60 35.60 <br /> Remaining for Health Ins 443.90 667.90 667.90 910.90 <br /> $25 Co-pay Mthly Premium 530.41 1,160.86 1,150.77 1,753.16 <br /> Monthly Employee Cost 86.51 492.96 482.87 842.26 <br /> Annual Employee Cost 1,038.12 5,915.52 5,794.44 10,107.12 <br /> Current Enrollment 10 0 1 0 <br /> $500 Ded Mthly Premium 459.25 1,005.13 996.41 1,518.00 <br /> Monthly Employee Cost 15.35 337.23 328.51 607.10 <br /> Annual Employee Cost 184.20 4,046.76 3,942.12 7,285.20 <br /> Current Enrollment 12 2 2 3 <br /> $2,500 HDHP Mthly Premium 372.47 815.19 808.11 1,231.11 <br /> Monthly Employee Cost -71.43 147.29 140.21 320.21 <br /> Annual Employee Cost -857.16 1,767.48 1,682.52 3,842.52 <br /> Current Enrollment 42 8 16 19 <br /> Employees electing the High Deductible Health Plan also receive a$41 per month($492.00 for the full <br /> year)contribution to their Health Savings Account. <br /> i <br /> N:\Public Bodies\City Council\Council RCA\Agenda Packet\10-15-2012\2013 Flexible Benefit Design RFA 10-15.docx <br />