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<br />7-la1Yfj;,v II/f/ocl <br />tt;! <br /> <br />2005 Renewal Options <br />Medica and Blue Cross Blue Shield <br /> <br /> Employee Employee <br /> Sinqle & Spouse & Child(ren) Familv <br />Amount Available for Health Insurance $318.03 $468.03 $468.03 $608.03 <br />Medica Renewal <br />Choice Select <br />$15 CoPa 419.48 856.67 762.42 1,421.11 <br />Monthly Employee Cost 101.45 388.64 294.39 813.08 <br />Annual Em 10 ee Cost 1,217.40 4,663.68 3,532.68 9,75696 <br />Elect/Essential <br />$15 CoPa 377.56 771.03 686.21 1,27903 <br />Monthly Employee Cost 59.53 303.00 218.18 671.00 <br />Annual Em 10 ee Cost 714.36 3,636.00 2,618.16 8,052.00 <br />Choice Select <br />$500 Deductible 357.46 730.00 649.69 1,210.98 <br />Monthly Employee Cost 39.43 261.97 181.66 602.95 <br />Annual Emplo ee Cost 473.16 3,143.64 2,179.92 7,235.40 <br />Elect/Essential <br />$500 Deductible 321.72 657.01 584.73 1,08988 <br />Monthly Employee Cost 3.69 188.98 116.70 481.85 <br />Annual Em 10 ee Cost 44.28 2,267.76 1,400.40 5,782.20 <br />Blue Cross Blue Shield <br />$15CoPa' 260.50 547.50 573.50 860.50 <br />Monthly Employee Cost (57.53) 79.47 105.47 252.47 <br />Annual Em 10 ee Cost 690.36) 953.64 1,265.64 3,029.64 <br />$500 Deductible 221.00 463.50 486.00 728.50 <br />Monthly Employee Cost (97.03) (4.53) 17.97 120.47 <br />Annual Em 10 ee Cost 1,164.36) 54.36) 215.64 1,445.64 <br />'Includes some 80/20 costs - mainly inpatient services <br /> <br />11/8/2004 <br />Finance Department <br />