| Type | Monthly | Annually |
| Actives | ||
| Family | $1361.00 | $16,332.00 |
| Participant only | $537.00 | $6,444.00 |
| Participant w/child(ren) | $837.00 | $10,044.00 |
| Medicare Retirees | ||
| Family | $562.00 | $6,744.00 |
| Participant only/or Surviving Spouse | $281.00 | $3,372.00 |
| *rounded to nearest $ |
|
Annual
Premiums
|
2009
|
|
|
|
Family
|
$13,728.00
|
|
|
Participant
w/child
|
$8,444.30
|
|
|
Participant
|
$5,418.86
|
|
|
||
|
Added
to Plan
(Active
and Medicare Secondary Participants)
|
||
|
|
Primary
Physician Co-Pay
|
$30.00
|
|
|
||
|
Changes
in Medical Plan
(Active
and Medicare Secondary Participants)
|
||
|
|
|
2009
|
|
|
Annual
Deductible
(per
person) $4,000.00 max per family
|
$2,000.00
|
|
|
Maximum
Out of Pocket per person (in Network)
|
$4,000.00
|
|
|
Out of
Pocket Max per person (out of Network)
|
$8,000.00
|
|
|
Per
Confinement Deductible
|
$500.00
|
|
|
||
|
Changes
in Drug Plan
(Active
and Medicare Primary Participants)
|
||
|
|
|
2009
|
|
|
Drug
Card Co-Pay
|
|
|
|
Generic
|
$10.00
|
|
|
Preferred
Brand
|
$40.00
|
|
|
Non
Preferred
|
$60.00
|
|
|
Mail
Order Co-Pay
(90
Day Supply)
|
|
|
|
Generic
|
$20.00
|
|
|
Preferred
Brand
|
$80.00
|
|
|
Non
Preferred
|
$120.00
|
|
Conference Group Medical Monthly Premiums |
|
| 2008 Premiums | |
| Active Participant Only | $410.52 |
| Active Partricipant with Child(ren) | $639.72 |
| Active Family | $1040.00 |
| Retired Participant Only | $210.00 |
| Retired Family | $420.00 |