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    Department of Finance

    Medical Benefits

    "Attention Members of Local 18/School Administrators AND Local 933/Teachers - The City will be holding a required re-enrollment for all Local 18 AND Local 933 members and their eligible dependents. All members are required to re-enrollin their choice of Medical Plans during this Open Enrollment Period.

    Medical Benefit INFORMATION Sessions for Local 18 and Local 933
    Note separate schedules for the INFO Sessions for each bargaining unit! The Medical Benefit Information Sessions will include brief presentations to review changes to your medical benefit plans which include the introduction of a High Deductible Health Savings Account eligible plan.

    Medical Benefit INFORMATION Sessions- Local 18 Only


    Day / Date

    Time

    Locations

    Tuesday, April 1

    4:00 p.m. (Session 1, Local 18)

    Hill Regional Career High School
    140 Legion Avenue

    Tuesday, April 1

    5:00 p.m. (Session 2, Local 18)

    Hill Regional Career High School
    140 Legion Avenue

    Medical Benefit INFORMATION Sessions Local 933 Only


    Day / Date

    Time

    Locations

    Thursday, March 27

    3:00 p.m. (Session 1, Local 933)
    4:30 p.m. (Session 2, Local 933)

    High School In the Community
    175 Water Street

    Tuesday, April 15
    NOTE Correction to new date:
    Thursday, April 10

    3:00 p.m. (Session 1, Local 933)
    4:30 p.m. (Session 2, Local 933)

    High School In the Community
    175 Water Street

    Although the INFORMATION sessions are not mandatory, information will be provided in these sessions that is critical to making a good decision and it will be presented in a detailed and in-depth manner which will not be possible during the Re-Enrollment meetings. You may attend whichever Session best fits your schedule. They will be conducted by representatives from Anthem Health Care Plans, Inc. and are designed to educate you about new medical benefit plan options and changes to the current plans that are effective with your new contract.

    To enroll in your choice of plans, please attend one of the below Re-Enrollment Sessions

     

    Medical Benefit RE-ENROLLMENT Sessions (Local 18 & 933)
    Attending one of the re-enrollment sessions is mandatory as you will be required to re-enroll yourself, spouse and eligible dependents. If you have questions on the plan options, be sure to attend one of the INFORMATION Sessions listed above. The final day to choose your health insurance is Thursday, May 1, 2014.

     

    Medical Benefit RE-ENROLLMENT Sessions - to sign up in your new plan

     

     

     

     

     

     

     

    Day / Date

    Time

    Location

     

     

    Tuesday, April 22

    2:30 p.m. to 6:00 p.m

    High School in the Community - Cafeteria

     

     

    Wednesday, April 23

    2:30 p.m. to 6:00 p.m

    High School in the Community - Cafeteria

     

     

    Thursday, April 24

    2:30 p.m. to 6:00 p.m

    High School in the Community - Cafeteria

     

     

    Tuesday, April 29

    2:30 p.m. to 6:00 p.m.

    Wilbur Cross H.S. - Atrium

     

     

    Wednesday, April 30

    2:30 p.m. to 6:00 p.m

    Wilbur Cross H.S. - Atrium

     

     

    Thursday, May 1

    2:30 p.m. to 6:00 p.m

    High School in the Community - Cafeteria

     

     

     

     

     

     

    Click on any of the below for more information:
    Local 18 - High Deductible Plan - Is it for me?
    Local 18 - How to use the Lumenos HSA
    Local 18 - Anthem's Lumenos HSA FAQ
    Local 18 Estimated Cost Shares FY 14-15

    Local 18 Medical Benefit Matrix New Plans
    Local 18 Prescription Drug Matrix
    Local 18 Dental Plan
    Local 18 Blue View Vision
    Local 18 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 18 - FAQs

    Local 933 - High Deductible Plan - Is it for me?
    Local 933 - How to use the Lumenos HSA
    Local 933 - Anthem's Lumenos HSA FAQ
    Local 933 Estimated Cost Shares FY 14-15

    Local 933 Medical Benefit Matrix New Plans
    Local 933 Prescription Drug Matrix
    Local 933 Dental Plan
    Local 933 Blue View Vision
    Local 933 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 933 - FAQs

    NEW STATE INSURANCE GUIDELINES FOR ADDING OR CHANGING DEPENDENTS

    Circumstances that are considered “Change of Life” and allow you to make additions of (to) dependents anytime throughout the year to your health plan are as follows:

    Marriage
    Birth of a child
    Adoption
    Assumption of legal guardianship or court ordered custody
    New step children
    Loss of coverage from another insurance carrier

    An Enrollment application must be submitted to The Department of Human Resources and Medical Benefits (Anthem BCBS )31 days from the time of qualifying event. If it is not received in the 31 days, you will not be able to add your dependent until the next open enrollment.

    Please see the Document Requirements list to review the necessary records.

    EMPLOYEE BENEFIT INFORMATION AND COST SHARES

    Local 18-School Administrators; Local 424-PW Laborers; Local 71-Blue Collar
    Locals 90 et al.-Tradesmen; Local 217-Cafeteria Food Service; Local 287-Custodians
    Local 530-Police; Local 825-Fire; Local 884-Clerical & Technical
    Local 933-Teachers; Local 3144-Management & Professional; Local 3429-Paraprofessionals
    Local 1303-102-NH Child Development; Executive & Confidential


    LOCAL 18 - SAA  Premium Cost Shares
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAY PERIOD DEDUCTIONS
    26 PAY PERIODS SINGLE 2 PERSON FAMILY
    HSA Eligible/HDHP (vision+dental) 13.98 27.44 34.79
    Century Preferred Mix (vision+dental) 67.16 141.85 179.13
    BlueCare POE (vision+dental) 118.19 243.89 311.78
    Century Preferred (vision+dental) 127.66 262.84 336.41
    21 PAY PERIODS SINGLE 2 PERSON FAMILY
    HSA Eligible/HDHP (vision+dental) 17.31 33.97 43.07
    Century Preferred Mix (vision+dental) 83.15 175.63 221.78
    BlueCare POE (vision+dental) 146.33 301.95 386.01
    Century Preferred (vision+dental) 158.05 325.42 416.51
    TERM LIFE
    as per contract NO COST TO EMPLOYEE

    Local 18 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 18 Bluecare POE HMO

    2014 SBC – 18 Century Preferred PPO

    2014 SBC – 18 Comp Mix PPO

    2014 SBC – 18 Lumenos HIA

    Local 424-PW Laborers PREMIUM COST SHARES
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    CP2-2006 Century Preferred 17% 31.73 64.31 83.07
    BC1-2006 Bluecare POE 13% 24.02 48.70 62.90
    BC2-2006 Bluecare POE 11% 19.29 39.13 50.53
    Full Pay Dental, ABCD 17% 1.30 3.37 4.69
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee

    "Click on any of the below for more information:
    Local 71 Premium Cost Shares, Effective April 1, 2014 - June 30, 2014
    Local 71 Medical Benefit Matrix New Plans 2013-2014
    Local 71 Health Incentive Account Lumenos HDHP
    Local 71 Prescription Drug Matrix
    Local 71 Dental Plan
    Local 71 Blue View Vision
    Local 71 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 71 - FAQs

    Local 71-Blue Collar PREMIUM COST SHARES
    FY 2013-2014 Effective  4/1/2013-6/30/2014
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 36.75 74.30 96.16
    Bluecare POE 19.25% 32.38 65.48 84.74
    Comp. Mix (CPCM) 15.25% 21.76 44.09 57.01
    Lumenos High Ded.  HIA 9.00% 11.57 23.59 30.88
    Full Pay Dental, ABCD 10.00% 0.76 1.98 2.76
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee

    Local 71 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 71 Bluecare POE HMO

    2014 SBC – 71 Century Preferred PPO

    2014 SBC – 71 Comp Mix PPO

    2014 SBC – 71 Lumenos HIA

    Local 90 et al.-Tradesmen PREMIUM COST SHARES
    FY 2013-2014 Effective  02/01/14-06/30/14
    PAYROLL DEDUCTIONS
    Paid 52 weeks 52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.3% 36.75 74.30 96.16
    Bluecare POE 16.0% 26.91 54.42 70.43
    Comp. Mix (CPCM) 15.25% 21.76 44.09 57.01
    Lumenos High Deductable 9.0% 10.90 21.77 28.37
    Bluecare 30 / 35 POE 12.5% 20.20 40.85 52.87
    Full Pay Dental, ABCD 10% 0.76 1.98 2.76
    TERM LIFE NO COST TO EMPLOYEE
    $25,000  per employee

    Trades click on any of the below for more information:
    Trades Premium Cost Shares, Effective February 1, 2014 - June 30, 2014
    Trades Medical Benefit Matrix New Plans 2013-2014
    Trades Health Incentive Account Lumenos HDHP
    Trades Prescription Drug Matrix
    Trades Dental Plan
    Trades Blue View Vision
    Trades Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Trades - FAQs

    Local Trades Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – Trades Bluecare POE HMO

    2014 SBC – Trades Century Preferred PPO

    2014 SBC – Trades Comp Mix PPO

    2014 SBC – Trades Lumenos HIA

    2014 SBC - Trades BC-1 POS


    LOCAL 217 Premium Cost Shares
    Cafeteria Food Service
    FY 2013-2014 Effective  3/1/2014-6/30/2014
    revised 01/2014
    PER PAY PERIOD DEDUCTIONS
    40 PAY PERIODS % SINGLE 2 PERSON FAMILY
    Full Pay Dental, ABCD 12% 1.19 3.09 4.30
    BlueView Vision 12% 0.16 0.28 0.44
    Medical through Unite Here Health 20.10 40.26 56.75
    TERM LIFE NO COST TO EMPLOYEE
    $8,000 per employee

    Eligible members of Local 217 are offered Medical Benefit coverage through UNITE HERE, and are offered Dental / Vision through Anthem. Click on the below for more information:

    Local 217 - UNITE HERE Health Enrollment Packet
    Local 217 - Anthem Enrollment Form for Dental & Vision Coverage
    Local 217 - UNITE HERE HEALTH Summary Plan Description
    Local 217 - UNITE HERE SBC 2014 (Summary of Benefits and Coverage)


    LOCAL 287-Custodians PREMIUM COST SHARES
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    WEEKLY DEDUCTIONS
    COVERAGE % SINGLE 2 PERSON FAMILY
    BC2-BLUECARE POS 14% 24.44 49.46 63.94
    LUMENOS HDHP/HSA 7.42 14.85 18.96
    FABCD DENTAL 14% 1.07 2.78 3.86
    TERM LIFE
    $25,000 per employee NO COST TO EMPLOYEE

    Local 530-Police PREMIUM COST SHARES
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    BC1-  POS 31% 57.98 117.13 151.65
    Century Preferred PPO 26% 44.96 90.90 117.65
    Bluecare POE 20% 33.64 68.03 88.04
    Cent Pref Comp Mix 16% 22.83 46.26 59.82
    Lumenos High Ded. HIA 13 15.74 31.45 40.98
    Full Pay Dental ABCD 15% 1.14 2.97 4.14
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee

    Members of Local 530 - Click on any of the below for more information:
    Local 530 Premium Cost Shares, Effective June 1, 2013 - June 30, 2013 AND Effective July 1, 2013 - June 30, 2014
    Local 530 Medical Benefit Matrix New Plans 2013-2014
    Local 530 BC-1 POS Matrix
    Local 530 Health Incentive Account Lumenos HDHP
    Local 530 Prescription Drug Matrix
    Local 530 Dental Plan
    Local 530 Blue View Vision
    Local 530 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 530 New Plans - FAQs

    Local 530 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 530 Bluecare POE HMO

    2014 SBC – 530 Century Preferred PPO

    2014 SBC – 530 Comp Mix PPO

    2014 SBC – 530 Lumenos HIA

    2014 SBC - 530 BC-1 POS


    LOCAL 825-Fire Premium Cost Shares
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAYROLL  DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % Single 2 Person Family
    CP2-825 Century Preferred 16.5% 31.62 64.21 82.88
    BC1-825 Bluecare POE 12.5% 23.88 48.50 62.59
    BC2-825 Bluecare POE 10.5% 18.98 38.57 49.76
    Full Pay Dental ABCD 16.5% 1.26 3.27 4.55
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee
    LOCAL 825 FIRE -- HIRED SINCE January 1, 2008
    BC-1 AND BC-2 Plans solely for the first four years of employment
    Employee contributes higher percentage for dependent coverage
    PAYROLL  DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % Single 2 Person Family
    BC1-825 Bluecare POE 12.5, 17.5% 23.88 67.89 87.62
    BC2-825 Bluecare POE 10.5, 16.5% 18.98 60.61 78.19
    Full Pay Dental ABCD 16.5% 1.26 3.27 4.55
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee

    Local 884 PREMIUM COST SHARES
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAYROLL DEDUCTIONS
    Paid 52 weeks 52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 36.75 74.30 96.16
    Bluecare POE 19.25% 32.38 65.48 84.74
    Comp. Mix 15.25% 21.76 44.09 57.01
    Lumenos High Ded.  HIA 9.00% 11.57 23.59 30.88
    Full Pay Dental, ABCD 10.00% 0.76 1.98 2.76
    Paid 42 weeks per year 42 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 45.50 91.99 119.05
     Bluecare POE 19.25% 40.09 81.07 104.91
    Comp. Mix 15.25% 26.94 54.59 70.59
    Lumenos High Ded.  HIA 9.00% 14.32 29.21 38.23
    Full Pay Dental, ABCD 10.00% 0.94 2.46 3.42
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 47.77 96.58 125.00
    Bluecare POE 19.25% 42.09 85.12 110.16
    Comp. Mix 15.25% 28.29 57.32 74.12
    Lumenos High Ded.  HIA 9.00% 15.04 30.67 40.14
    Full Pay Dental, ABCD 10.00% 0.99 2.58 3.59
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 73.49 148.59 192.31
    Bluecare POE 19.25% 64.75 130.96 169.47
    Comp. Mix 15.25% 43.52 88.19 114.03
    Lumenos High Ded.  HIA 9.00% 23.14 47.19 61.75
    Full Pay Dental, ABCD 10.00% 1.53 3.97 5.52
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 90.99 183.97 238.10
    Bluecare POE 19.25% 80.17 162.14 209.82
    Comp. Mix 15.25% 53.88 109.18 141.18
    Lumenos High Ded.  HIA 9.00% 28.64 58.42 76.45
    Full Pay Dental, ABCD 10.00% 1.65 4.30 5.98
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
    Local 884 PREMIUM COST SHARES
    Local 884-PT PEO FULLY EQUIVALENT PREMIUM COSTS
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    MONTHLY COSTS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 100% 778.04 1593.34 2068.18
    Bluecare POE 100% 757.52 1552.28 2014.81
    Comp. Mix 100% 618.29 1252.92 1620.06
    Lumenos High Ded.  HIA 100% 524.63 1048.17 1365.95
    Full Pay Dental, ABCD 100% 33.05 85.94 119.58
    PLEASE NOTE THAT MONTHLY COSTS WILL CHANGE EVERY JULY 1ST.
    MONTHLY PAYMENTS ARE DUE BY THE 1st OF THE MONTH OF COVERAGE.
    CHECKS ARE MADE PAYABLE TO "TREASURER-CITY OF NEW HAVEN"
    AND BROUGHT OR MAILED TO THE MEDICAL BENEFITS DIVISION,
    1ST FLOOR, 200 ORANGE STREET, NEW HAVEN, CT 06510.

    Members of Local 884 - Click on any of the below for more information
    Local 884 Premium Cost Shares,
    Effective 11/1/2012-6/30/2012
    Local 884 Medical Benefit Matrix 2012-2013
    Local 884 Health Incentive Account Lumenos HDHP
    Local 884 Dental Plan
    Local 884 Blue View Vision
    Local 884 Enrollment and Membership Change Form

    Local 884 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 884 Bluecare POE HMO

    2014 SBC – 884 Century Preferred PPO

    2014 SBC – 884 Comp Mix PPO

    2014 SBC – 884 Lumenos HIA


    LOCAL 933-Teachers Premium Cost Shares
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    Effective School Year 2013-2014
    PAY PERIOD DEDUCTIONS
    21 PAY PERIODS % SINGLE 2 PERSON FAMILY
    CP2-2010 Century Preferred 21.5% 95.33 192.90 249.34
    BC1-2010 Bluecare POE 17.5% 77.42 156.67 202.51
    CPCM-2010 Cent Pref Comp Mix 10.5% 41.77 84.64 109.34
    Full Pay Dental-2010 ABCD 21.5% 4.16 10.81 15.04
    TERM LIFE
    $55,000 PER EMPLOYEE NO COST TO EMPLOYEE

    Local 933 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 933 Bluecare POE HMO

    2014 SBC – 933 Century Preferred PPO

    2014 SBC – 933 Comp Mix PPO

    2014 SBC – 933 Lumenos HIA

    Local 3144-Management PREMIUM COST SHARES
    FY 2013-2014 Effective  11/01/13-06/30/14
    PAYROLL DEDUCTIONS
    Paid 52 weeks 52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 37.18 75.17 97.29
    Bluecare POE 19.5% 32.80 66.33 85.84
    Comp. Mix (CPCM) 15.5% 22.12 44.82 57.95
    Lumenos High Deductable 11.0% 13.32 26.61 34.67
    Full Pay Dental, ABCD 15% 1.14 2.97 4.14
       
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 48.33 97.72 126.48
    Bluecare POE 19.5% 42.64 86.23 111.59
    Comp. Mix (CPCM) 15.5% 28.76 58.27 75.34
    Lumenos High Deductable 11.0% 17.32 34.59 45.07
    Full Pay Dental, ABCD 15% 1.48 3.86 5.38
       
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 74.36 150.34 194.58
    Bluecare POE 19.5% 65.60 132.66 171.67
    Comp. Mix (CPCM) 15.5% 44.23 89.63 115.90
    Lumenos High Deductable 11.0% 26.64 53.21 69.35
    Full Pay Dental, ABCD 15% 2.29 5.95 8.28
       
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 92.06 186.13 240.90
    Bluecare POE 19.5% 81.21 164.24 212.55
    Comp. Mix (CPCM) 15.5% 54.76 110.97 143.49
    Lumenos High Deductable 11.0% 32.98 65.88 85.86
    Full Pay Dental, ABCD 15% 2.83 7.37 10.25
       
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee

    Local 3144/Executive Management - Click on any of the below for more information:
    Local 3144 / Executive Management Premium Cost Shares, Effective November, 2013 - June 30, 2013
    Local 3144 / Executive Management Medical Benefit Matrix New Plans 2013-2014
    Local 3144 / Executive Management Health Incentive Account Lumenos HDHP
    Local 3144 / Executive Management Prescription Drug Matrix
    Local 3144 / Executive Management Dental Plan
    Local 3144 / Executive Management Blue View Vision
    Local 3144 / Executive Management Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 3144 New Plans - FAQs

    Local 3144 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 3144 Bluecare POE HMO

    2014 SBC – 3144 Century Preferred PPO

    2014 SBC – 3144 Comp Mix PPO

    2014 SBC – 3144 Lumenos HIA

    Local 3144/Executive Management - Click on any of the below for more information:
    Local 3144 / Executive Management Premium Cost Shares, Effective November, 2013 - June 30, 2013
    Local 3144 / Executive Management Medical Benefit Matrix New Plans 2013-2014
    Local 3144 / Executive Management Health Incentive Account Lumenos HDHP
    Local 3144 / Executive Management Prescription Drug Matrix
    Local 3144 / Executive Management Dental Plan
    Local 3144 / Executive Management Blue View Vision
    Local 3144 / Executive Management Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 3144 New Plans - FAQs

    Executive Management Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – EM Bluecare POE HMO

    2014 SBC – EM Century Preferred PPO

    2014 SBC – EM Comp Mix PPO

    2014 SBC – EM Lumenos HIA


    LOCAL 3429 Premium Cost Shares
    Paraprofessionals Effective School Year 2013-2014
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAY PERIOD DEDUCTIONS
    21 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 20.25% 86.71 175.31 226.90
    Bluecare POE 18.25% 76.01 153.72 198.92
    Cent Pref Comp Mix 14.25% 50.35 102.02 131.92
    Lumenos High Ded. HIA 7.00% 20.99 41.93 54.64
    Full Pay Dental ABCD 10.00% 1.89 4.91 6.83
    TERM LIFE NO COST TO EMPLOYEE
    $25,000 per employee

    Members of Local 3429 - Click on any of the below for more information:
    Local 3429 Premium Cost Shares, Effective May 1, 2013 - June 30, 2013 AND Effective July 1, 2013 - June 30, 2014
    Local 3429 Medical Benefit Matrix 2013-2014
    Local 3429 Health Incentive Account Lumenos HDHP
    Local 3429 Prescription Comparison
    Local 3429 Dental Plan
    Local 3429 Blue View Vision
    Local 3429 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 3429 New Plans - FAQs

    Local 3429 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 3429 Bluecare POE HMO

    2014 SBC – 3429 Century Preferred PPO

    2014 SBC – 3429 Comp Mix PPO

    2014 SBC – 3429 Lumenos HIA


    LOCAL 1303-102 PREMIUM COST SHARES
    NH CHILD DEVELOPMENT
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % Single 2 Person Family
    BC1-1303-102 Bluecare POE 12% 22.17 44.95 58.06
    BC2-1303-102 Bluecare POE 10% 17.53 35.58 45.94
    Full Pay Dental ABCD 12% 0.92 2.38 3.31

    Executive & Confidential PREMIUM COST SHARES
    FY 2013-2014 Effective  11/01/13-06/30/14
    PAYROLL DEDUCTIONS
    Paid 52 weeks 52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 37.18 75.17 97.29
    Bluecare POE 19.5% 32.80 66.33 85.84
    Comp. Mix (CPCM) 15.5% 22.12 44.82 57.95
    Lumenos High Deductable 11.0% 13.32 26.61 34.67
    Full Pay Dental, ABCD 15% 1.14 2.97 4.14
       
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 48.33 97.72 126.48
    Bluecare POE 19.5% 42.64 86.23 111.59
    Comp. Mix (CPCM) 15.5% 28.76 58.27 75.34
    Lumenos High Deductable 11.0% 17.32 34.59 45.07
    Full Pay Dental, ABCD 15% 1.48 3.86 5.38
       
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 74.36 150.34 194.58
    Bluecare POE 19.5% 65.60 132.66 171.67
    Comp. Mix (CPCM) 15.5% 44.23 89.63 115.90
    Lumenos High Deductable 11.0% 26.64 53.21 69.35
    Full Pay Dental, ABCD 15% 2.29 5.95 8.28
       
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.5% 92.06 186.13 240.90
    Bluecare POE 19.5% 81.21 164.24 212.55
    Comp. Mix (CPCM) 15.5% 54.76 110.97 143.49
    Lumenos High Deductable 11.0% 32.98 65.88 85.86
    Full Pay Dental, ABCD 15% 2.83 7.37 10.25
       
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee



     

     

     

     

     

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