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Premium Rates
Effective July 1, 2008 - June 30, 2009
Active Participants (charge to your dollar bank):
| |
IBEW PPO |
Group
Health |
|
|
Medical |
$ |
630.01 |
$ |
661.24 |
|
|
Dental |
|
112.85 |
|
112.85 |
|
|
Vision |
|
9.32 |
|
9.32 |
|
|
Weekly Disability ($250/wk)*** |
|
4.95 |
|
4.95 |
|
|
Life/AD&D |
|
5.00 |
|
5.00 |
|
|
Total Monthly Premium |
$ |
762.13 |
$ |
793.36 |
|
|
Less Trust Subsidy |
|
(6.50) |
|
(6.50) |
|
|
Monthly Charge to Your Dollar Bank |
$ |
755.63 |
$ |
786.86 |
|
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 |
$ |
774.63 |
$ |
805.86 |
|
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, 2008 - June 30, 2009:
[Top of Page]
| |
IBEW PPO |
Group
Health HMO |
|
|
Medical, Dental, Vision & Life |
$ |
782.18 |
$ |
813.41 |
|
|
Medical Only |
|
655.01 |
|
686..24 |
|
Retiree Rates Effective July
1, 2008 - June 30, 2009:
[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 |
$ |
467.06 |
|
|
Two Under 65 - (6) |
|
939.22 |
|
1,174.38 |
|
|
One Over / One Under 65 - (4) |
|
779.86 |
|
820.72 |
|
|
One Over 65 - (2) |
|
310.25 |
|
233.53 |
|
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One Under 65 - (3) |
|
469.61 |
|
587.19 |
|
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Each non-spouse dependent |
200.13 |
171.33 |
|
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(2nd+150.39) |
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Subsidized Retiree Rates Effective July
1, 2008 - June 30, 2009:
[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 |
$ |
592.85 |
$ |
690.67 |
|
|
Dental |
|
106.26 |
|
106.26 |
|
|
Vision |
|
9.32 |
|
9.32 |
|
|
Total Premiums |
$ |
722.68 |
$ |
847.09 |
|
|
|
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Subsidized Retiree Co-Payment |
|
|
|
Participant
20% |
$ |
151.00 |
$ |
157.00 |
|
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Participant & Spouse
30% |
|
226.50 |
|
235.50 |
|
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Each Dependant
10% |
|
75.50 |
|
78.50 |
|
| |
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Non-Bargaining Unit Rates Effective July 1, 2008 - June 30, 2009
| |
IBEW PPO |
Group
Health HMO |
|
|
Medical, Dental & Vision |
$ |
752.18 |
$ |
783.41 |
|
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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