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    Department of Finance

    Medical Benefits

    **************

    April 2016

    ANNUAL OPEN ENROLLMENT FOR MEDICAL BENEFITS
    May 2, 2016 -June 15, 2016

    The City is sponsoring the annual open enrollment for medical benefits. This is the opportunity for eligible employees to make changes their current medical coverage, effective July 1, 2016-June 30, 2017. Please note the effective date of these changes to 10-month employees will be September 1, 2014, unless otherwise noted.

    If you wish to keep your current medical coverage and there are no additions to your enrolled dependents, you do nothing and can disregard this notice.

    Information on available plans, including plan matrices, current cost shares, and enrollment forms can be found by scrolling down on this page.

    An Anthem representative will be available to answer your questions on
    Monday, May 9, 2016 from 12:00 p.m. to 3:00 p.m.
    Tuesday, May 24 from 2:00 p.m. to 5:00 p.m.
    Tuesday, June 7 from 10:00 a.m. to 1:00 p.m.

    at the Human Resource & Medical Benefits Office, 200 Orange St., Room 102.
    You can also reach her by phone on those days, at 203-946-8255.

    If you want to enroll or to change coverage, please be advised the deadline for submission of the required information is June 15, 2016 by 4:30 p.m. If the forms are not submitted by this deadline, your next opportunity to change health care plans will be next year.

    Should you have any questions, please feel free to call
    Medical Benefits Division at 203-946-6766 or 203-946-7157
    or email your questions to Susan Baldwin at sbaldwin@newhavenct.gov.

    A pdf of this Annual Open Enrollment notice is available HERE

     

    **************

    NEW RELEASE - 02/19/2016
    The 1095-C Form-Information for City of New Haven Employees
    As many of you are aware, 2015 is the first year in which employers are required under the Affordable Care Act (ACA) to furnish employees with a form 1095-C. Because so many employers were struggling to meet this requirement, in late December the IRS issued a notice moving back the deadline for providing these forms from January 31, 2016 to March 31, 2016. Recognizing that this would impact the individual taxpayer's ability to file their 2015 income taxes in a timely manner, they also dropped the requirement that the 2015 1095-C be filed with your return.
    What does that mean for you? The City intends to furnish the required 1095-C to all eligible employees by the March 31, 2016 deadline. Employees should feel free to file their 2015 federal tax return without waiting for the 1095-C. The IRS has made it clear it is not required for this tax year.

     Linked HERE is a memo which provides some general information about the form itself and ACA reporting requirements.

     

    **************
    NEW RELEASE - 02/13/2015
    ANTHEM UPDATE: How To Enroll in Credit Protection Services Offered by Anthem Blue Cross & Blue Shield

    Today, Anthem Blue Cross and Blue Shield, provided information on how to immediately enroll in credit protection services to all members who are potentially impacted by the Cyber Attack.

    Starting 02/13/15 at 2 p.m. ET/11 a.m. PT, current and former Anthem Blue Cross and Blue Shield members can visit AnthemFacts.com to learn more about credit monitoring and identity theft repair services provided by AllClear ID, a leading and trusted identity protection provider. All services are available for two years. Details of the services, and instructions on how to enroll, are available on this Memo to all Employees, 02/13/15 HERE:

    An additional FAQ sheet from Anthem is available HERE

    ************
    Important Information Regarding Cyber Attack Impacting Anthem, Inc.

    We are continuing to work closely with Anthem to better understand the cyber attack and the impact on our employees. Anthem has created a website - www.anthemfacts.com, and a hotline, 1-877-263-7995, for its members to call for more information, and has shared the attached Frequently Asked Questions (FAQs) that further explains the cyber attack. We will continue to keep you updated on Anthem's ongoing investigation in hopes to find out who committed the attack, and why.

    See Memo to all Employees 02/05/2015 HERE

    ************

    **************
    NEW RELEASE -
    ANTHEM ALERTS CONSUMERS TO PROTECT THEMSELVES FROM SCAM EMAIL CAMPAIGNS

    Connecticut residents who may have been impacted by the cyber-attack against Anthem, should be aware of scam email campaigns targeting current and former Anthem members. These scams, designed to capture personal information (known as "phishing") are designed to appear as if they are from Anthem and the emails include a "click here" link for credit monitoring. These emails are NOT from Anthem.

    See Memo to all Employees 02/06/2015 HERE



    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 and Membership Change Form must be submitted to The Department of Human Resources and Medical Benefits within 31 days from the date of qualifying event. If it is not received in the 31 days, you will not be able to add your dependent until the next annual Open Enrollment. Forms are available at the Department of Human Resources and Medical Benefits at 200 Orange Street, or below with the corresponding Bargaining Unit information.

    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

    Elm City Local of the CT Alliance of City Police;
    Local 825-Fire
    ;
    Local 884-Clerical & Technical

    Local 933-Teachers;
    Local 1303-102-NH Child Development;
    Local 1303-464 - Attorneys
    Local 3144-Management & Professional;
    Local 3429-Paraprofessionals

    Executive & Confidential


    LOCAL 18 - SAA   
      Premium Cost Shares
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    26 PAY PERIODS SINGLE 2 PERSON FAMILY
    %*
    Lumenos High Deductible H.S.A. 14% 44.36 88.64 115.30
    Century Preferred Comp Mix (CPCM) Buy-Up 146.64 306.81 392.69
    BlueCare POE Buy-Up 173.91 361.36 463.61
    Century Preferred PPO Buy-Up 188.24 390.01 500.85
    Dental, ABCD 14% 2.34 6.09 8.47
    21 PAY PERIODS SINGLE 2 PERSON FAMILY
    %*
    Lumenos High Deductible H.S.A. 14% 54.92 109.74 142.75
    Century Preferred Comp Mix (CPCM) Buy-Up 181.55 379.85 486.19
    BlueCare POE Buy-Up 215.32 447.40 574.00
    Century Preferred PPO Buy-Up 233.06 482.87 620.10
    Dental, ABCD 14% 2.90 7.54 10.49
    TERM LIFE
    as per contract NO COST TO EMPLOYEE
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.
    Buy-Up: employee pays the applicable co-pay for the HSA plan, plus the difference in rate between the HSA and the FIE rate for the selected plan.
                 

    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 Cost Shares FY 16-17
    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
    Local 18 HSA Election Salary Reduction Form 2016
    Re-Enrollment Document Requirements
    Local 18 - FAQs

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

    2016-2017 SBC - Local 18 Bluecare

    2016-2017 SBC - Local 18 Century Preferred PPO

    2016-2017 SBC - Local 18 Century Preferred Comp Mix

    2016-2017 SBC - Local 18 Lumenos HSA

    Local 424-PW Laborers  
      PREMIUM COST SHARES
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 48.46 98.43 127.09
    Bluecare POE 19.25% 42.52 86.41 111.54
    Century Preferred Comp Mix (CPCM) 15.25% 31.60 64.29 82.96
    Lumenos High Deductible HIA 11.00% 16.55 33.06 43.00
    Dental, ABCD 10.00% 0.84 2.17 3.03
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    Click on any of the below for more information:

    Local 424 Cost Shares 16-17
    Local 424 Medical Benefit Matrix New Plans effective April 1, 2015
    Local 424 Health Incentive Account Lumenos HDHP
    Local 424 Prescription Drug Matrix
    Local 424 Dental Plan
    Local 424 Blue View Vision
    Local 424 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 424 - FAQs

    Local 424 Summary of Benefits and Coverage (SBC) by plan

    2016-2017 SBC-Local 424 Bluecare

    2016-2017 SBC-Local 424 Century Preferred PPO

    2016-2017 SBC-Local 424 Century Preferred Comp Mix

    2016-2017 SBC-Local 424 Lumenos HIA

     


    Local 71-Blue Collar  
      PREMIUM COST SHARES
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    52 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 48.46 98.43 127.09
    Bluecare POE 19.25% 42.52 86.41 111.54
    Century Preferred Comp Mix (CPCM) 15.25% 31.60 64.29 82.96
    Lumenos High Deductible HIA 11.00% 17.29 34.54 44.97
    Dental, ABCD 10.00% 0.84 2.17 3.03
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

     

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

    2016-2017 SBC-Local 71 Bluecare

    2016-2017 SBC-Local 71 Century Preferred PPO

    2016-2017 SBC-Local 71 Century Preferred Comp Mix

    2016-2017 SBC-Local 71 Lumenos HIA

    Click on any of the below for more information:
    Local 71 Cost Shares FY 16-17
    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 90 et al.-Tradesmen  
      PREMIUM COST SHARES
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    52 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.25% 53.02 107.69 139.05
    Bluecare POE 19.00% 41.97 85.28 110.10
    Century Preferred Comp Mix (CPCM) 17.25% 35.75 72.72 93.84
    Lumenos High Deductible HIA 15.00% 23.57 47.10 61.33
    Bluecare 30 / 35 POE 15.50% 33.20 67.44 87.08
    Dental, ABCD 10.00% 0.84 2.17 3.03
    TERM LIFE
    $25,000 per employee NO COST TO EMPLOYEE
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    Trades click on any of the below for more information:
    Trades Cost Shares FY 16-17
    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 Effective School Year 2016-2017
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    40 PAY PERIODS %* SINGLE 2 PERSON FAMILY
    Unite Here Health Plan 10% 21.91 43.88 61.86
    (note Unite Here Health Plan costs are effective 01/01/2016-12/31/2016)
    Blue View Vision 12% 0.18 0.32 0.51
    Dental, ABCD 12% 1.31 3.40 4.74
    TERM LIFE NO COST TO EMPLOYEE
    $8,000 per employee
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    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
    Custodial, Board of Education Effective  07/01/2016-06/30/2017
    FY 2016-2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    COVERAGE %* SINGLE 2 PERSON FAMILY
    BC2-BlueCare POS 17% 39.56 80.54 103.82
    Lumenos High Deductible HIA 14.79 29.58 38.46
    Dental, ABCD 17% 1.42 3.70 5.14
    TERM LIFE
    $25,000 per employee NO COST TO EMPLOYEE
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    Local 287 - Enrollment and Membership Change Form
    Local 287 Plans Matrix
    Local 287 Cost Shares FY 16-17


    Elm City Local-of the CT Alliance of City Police (previously Local 530)  
      PREMIUM COST SHARES
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    COVERAGE %* SINGLE 2 PERSON FAMILY
    BC1- POS 33% 77.73 157.80 203.80
    Century Preferred PPO 28% 63.85 129.69 167.46
    Bluecare POE 22% 48.59 98.75 127.48
    Century Preferred Comp Mix (CPCM) 18% 37.30 75.89 97.92
    Lumenos High Deductible HIA 15% 22.00 43.96 57.24
    Dental, ABCD 15% 1.25 3.26 4.54
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    Members of Elm City Local - Click on any of the below for more information:
    Elm City Local Cost Shares FY 16-17
    Elm City Local Medical Benefit Matrix New Plans 2013-2014
    Elm City Local BC-1 POS Matrix
    Elm City Local Health Incentive Account Lumenos HDHP
    Elm City Local Prescription Drug Matrix
    Elm City Local Dental Plan
    Elm City Local Blue View Vision
    Elm City Local Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Elm City Local New Plans - FAQs

    Elm City Local Summary of Benefits and Coverage (SBC) by plan

    2016-2017 SBC-Elm City Local Bluecare

    2016-2017 SBC-Elm City Local Century Preferred PPO

    2016-2017 SBC-Elm City Local Century Preferred Comp Mix

    2016-2017 SBC-Elm City Local Lumenos HIA

    2016-2017 SBC-Elm City Local BC-1 POS


    LOCAL 825-Fire  
      Premium Cost Shares
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    COVERAGE %* Single 2 Person Family
    Century Preferred PPO Buy-Up 81.91 171.82 218.66
    High Deductible H.S.A.  14.5% 25.52 51.01 66.35
    Dental, ABCD 14.5% 1.21 3.15 4.39
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.
    Buy-Up: employee pays the applicable co-pay for the HSA plan, plus the difference in rate between the HSA and the FIE rate for the selected plan.

    "Click on any of the below for more information:


    Local 825 Cost Shares 16-17
    Local 825 Medical Benefit Matrix New Plans
    Local 825 Prescription Drug Matrix
    Local 825 Dental Plan
    Local 825 Blue View Vision
    Local 825 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 825 - NEW PLAN Choices FAQs
    Local 825 - HDHP / HSA Frequently Asked Questions and Information
    Local 825 HSA Election Salary Reduction Form 2016


    Local 884  
      PREMIUM COST SHARES
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    Paid 52 weeks per year 52 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 48.46 98.43 127.09
    Bluecare POE 19.25% 42.52 86.41 111.54
    Century Preferred Comp Mix (CPCM) 15.25% 31.60 64.29 82.96
    Lumenos High Deductible HIA 11.00% 18.00 36.49 47.64
    Dental, ABCD 10.00% 0.84 2.17 3.03
    Paid 42 weeks per year 42 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 60.00 121.86 157.35
    Bluecare POE 19.25% 52.64 106.98 138.10
    Century Preferred Comp Mix (CPCM) 15.25% 39.13 79.60 102.71
    Lumenos High Deductible HIA 11.00% 22.28 45.18 58.99
    Dental, ABCD 10.00% 1.04 2.69 3.75
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 63.00 127.96 165.22
    Bluecare POE 19.25% 55.28 112.33 145.01
    Century Preferred Comp Mix (CPCM) 15.25% 41.09 83.58 107.85
    Lumenos High Deductible HIA 11.00% 23.40 47.44 61.93
    Dental, ABCD 10.00% 1.09 2.83 3.93
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.
    Local 884 PREMIUM COST SHARES
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 96.92 196.85 254.18
    Bluecare POE 19.25% 85.04 172.81 223.09
    Century Preferred Comp Mix (CPCM) 15.25% 63.21 128.58 165.92
    Lumenos High Deductible HIA 11.00% 35.99 72.99 95.28
    Dental, ABCD 10.00% 1.67 4.35 6.05
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 120.00 243.72 314.70
    Bluecare POE 19.25% 105.29 213.96 276.21
    Century Preferred Comp Mix (CPCM) 15.25% 78.26 159.20 205.42
    Lumenos High Deductible HIA 11.00% 44.56 90.37 117.97
    Dental, ABCD 10.00% 1.81 4.71 6.56
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.
               
    Local 884 Premium Cost Shares
    Local 884-Part Time PEO FULLY EQUIVALENT PREMIUM COSTS
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    MONTHLY COSTS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 100% 1019.42 2092.58 2708.69
    Bluecare POE 100% 988.38 2030.58 2628.01
    Century Preferred Comp Mix (CPCM) 100% 898.06 1826.87 2357.29
    Lumenos High Deductible HIA 100% 681.03 1360.80 1771.68
    Dental, ABCD 100% 36.24 94.23 131.11
    Please note that monthly costs will change every July 1st. Monthly payments are due by the
    1st of the month of coverage. Checks made payable to "Treasurer - City of New Haven"
    and brought or mailed to the Medical Benefits Division, 200 Orange St 1st Fl, New Haven.
                 

    Members of Local 884 - Click on any of the below for more information
    Local 884 Cost Shares FY 16-17
    Local 884 Medical Benefit Matrix
    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

    2016-2017 SBC-Local 884 Bluecare

    2016-2017 SBC-Local 884  Century Preferred PPO

    2016-2017 SBC-Local 884 Century Preferred Comp Mix

    2016-2017 SBC-Local 884 Lumenos HIA


    LOCAL 933-Teachers  
      Premium Cost Shares
    FY 2016-2017 Effective  07/01/2016-06/30/2017
    Effective School Year 2016-2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    21 PAY PERIODS %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 22.5% 130.19 264.47 341.47
    BlueCare POE 18.5% 104.18 211.74 273.32
    Century Preferred Comp Mix (CPCM) 14.0% 77.18 157.03 202.61
    Lumenos High Deductible H.S.A. 13.0% 54.92 109.74 142.75
    Dental, ABCD 15.0% 3.29 8.56 12.19
    Employees hired after July 1, 2010 and scheduled to work 20 or more hours per week, and their eligible dependents, are only eligible for the Century Preferred Comp Mix (CPCM) or Lumenos HD HSA plans, as per Article XIII, Section 1 (a) of the Local 933, AFT, AFL-CIO contract.
    TERM LIFE
    $75,000 PER EMPLOYEE NO COST TO EMPLOYEE
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    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 Cost Shares FY 16-17
    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
    Local 933 HSA Election Salary Reduction Form 2016
    Re-Enrollment Document Requirements
    Local 933 - FAQs

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

    2016-2017 SBC-Local 933 Bluecare

    2016-2017 SBC-Local 933  Century Preferred PPO

    2016-2017 SBC-Local 933 Century Preferred Comp Mix

    2016-2017 SBC-Local 933 Lumenos HSA

    Medical Benefit Waiver / Opt-Out Program
    As noted in your most recent bargaining unit contract, only those Teachers who received a Medical Benefit Opt Out payment for the 2013-14 school year will be eligible to continue to participate in the Opt Out  payment program. Those eligible Teachers will receive information regarding the Re-Enrollment process by mail. If you have not received any information for the annual payment for school year 2015-2016, or, if you believe the information you received is incorrect, please contact Susan Baldwin at sbaldwin@newhavenct.gov

    To review instructions for the Medical Benefit Waiver Opt Out, click HERE.

    Click HERE to download a pdf of the Year 2016-2017 Waiver / Opt-Out Form


    LOCAL 1303-464 Attorneys  
      PREMIUM COST SHARES
    Corporation Counsel Effective  07/01/2016-06/30/2017
    FY 2016-2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    COVERAGE %* Single 2 Person Family
    Century Preferred PPO 23.50% 53.59 108.85 140.55
    BlueCare POE 21.50% 47.49 96.51 124.58
    Century Preferred Comp Mix (CPCM) 16.00% 36.27 73.78 95.20
    Lumenos High Deductible HIA 13.00% 19.55 39.07 50.82
    Dental, ABCD 15.00% 1.25 3.26 4.54
    TERM LIFE 20,000 NO COST TO EMPLOYEE
    if salary over $50,000 100,000 NO COST TO EMPLOYEE
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    Local 1303-464 Attorneys – Click on any of the below for more information.
    Local 1303-464 Enrollment and Membership Change Form
    Local 1303-464 Medical Benefit Matrix, effective 04/01/2016
    Local 1303-464 Blue View Vision
    Local 1303-464 Dental Plan Information
    Local 1303-464 Prescription Drug Matrix
    Local 1303-464 Cost Shares FY 16-17
    Local 1303-464 Lumenos Health Incentive Account Info
    Local 1303-464 New Plan FAQs
    Re-Enrollment Requirements

    Local 1303-464 Summary of Benefits and Coverage (SBC) by plan

    2016-2017 SBC-Local 1303-464 Bluecare

    2016-2017 SBC-Local 1303-464Century Preferred PPO

    2016-2017 SBC-Local 1303-464Century Preferred Comp Mix

    2016-2017 SBC-Local 1303-464Lumenos HIA

     


    Local 3144-Management  
      PREMIUM COST SHARES
    FY 2016-2017 Effective 07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    Paid 52 weeks per year 52 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 52.45 106.53 137.56
    BlueCare POE 21.0% 46.39 94.26 121.68
    Century Preferred Comp Mix (CPCM) 17.0% 35.23 71.67 92.48
    Lumenos High Deductible HIA 12.0% 18.05 36.06 46.91
    Dental, ABCD 15.0% 1.25 3.26 4.54
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 68.19 138.49 178.82
    BlueCare POE 21.0% 60.30 122.54 158.19
    Century Preferred Comp Mix (CPCM) 17.0% 45.80 93.17 120.22
    Lumenos High Deductible HIA 12.0% 23.46 46.88 60.99
    Dental, ABCD 15.0% 1.63 4.24 5.90
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 104.90 213.07 275.11
    BlueCare POE 21.0% 92.77 188.52 243.37
    Century Preferred Comp Mix (CPCM) 17.0% 70.46 143.34 184.96
    Lumenos High Deductible HIA 12.0% 36.10 72.13 93.83
    Dental, ABCD 15.0% 2.51 6.52 9.08
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 129.88 263.80 340.62
    BlueCare POE 21.0% 114.86 233.41 301.32
    Century Preferred Comp Mix (CPCM) 17.0% 87.24 177.47 228.99
    Lumenos High Deductible HIA 12.0% 44.69 89.30 116.17
    Dental, ABCD 15.0% 3.11 8.08 11.24
    TERM LIFE
    $20,000 per employee NO COST TO EMPLOYEE
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

    Local 3144/Executive Management - Click on any of the below for more information:
    Local 3144 / Executive Management Cost Shares FY 16-17
    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

    2016-2017 SBC-Local 3144 Bluecare

    2016-2017 SBC-Local 3144 Century Preferred PPO

    2016-2017 SBC-Local 3144 Century Preferred Comp Mix

    2016-2017 SBC-Local 3144 Lumenos HIA


    LOCAL 3429  
      PREMIUM COST SHARES
    Paraprofessionals Effective School Year 2016-2017
    FY 2016-2017 Effective 07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    21 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 20.25% 114.35 232.25 299.89
    Bluecare POE 18.25% 99.82 202.84 261.86
    Century Preferred Comp Mix (CPCM) 14.25% 73.13 148.76 191.95
    Lumenos High Deductible HIA 7.00% 27.24 54.43 70.87
    Dental, ABCD 10.00% 2.07 5.38 7.49
    TERM LIFE NO COST TO EMPLOYEE
    $25,000 per employee
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.
                 

    Members of Local 3429 - Click on any of the below for more information:
    Local 3429 Cost Shares FY 16-17
    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

    2016-2017 SBC-Local 3429 Bluecare

    2016-2017 SBC-Local 3429 Century Preferred PPO

    2016-2017 SBC-Local 3429 Century Preferred Comp Mix

    2016-2017 SBC-Local 3429 Lumenos HIA


    Executive & Confidential  
      PREMIUM COST SHARES
    FY 2016-2017 Effective 07/01/2016-06/30/2017
    PAYROLL DEDUCTIONS
    DEDUCTION EACH PAY PERIOD
    52 PAY PERIODS
    COVERAGE %* SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 52.45 106.53 137.56
    Bluecare POE 21.0% 46.39 94.26 121.68
    Century Preferred Comp Mix (CPCM) 17.0% 35.23 71.67 92.48
    Lumenos High Deductible HIA 12.0% 18.05 36.06 46.91
    Dental, ABCD 15.0% 1.25 3.26 4.54
    26 PAY PERIODS
    COVERAGE %* Single 2 Person Family
    Century Preferred PPO 23.0% 104.90 213.07 275.11
    Bluecare POE 21.0% 92.77 188.52 243.37
    Century Preferred Comp Mix (CPCM) 17.0% 70.46 143.34 184.96
    Lumenos High Deductible HIA 12.0% 36.10 72.13 93.83
    Dental, ABCD 15.0% 2.51 6.52 9.08
    TERM LIFE 20,000 NO COST TO EMPLOYEE
    if salary over $50,000 100,000 NO COST TO EMPLOYEE
    % * The employee contributes this percent of the fully insured equivalent (FIE) rate.

     

    Local 3144/Executive Management - Click on any of the below for more information:
    Executive Management Cost Shares FY 16-17
    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

    2016-2017 SBC-EM Bluecare

    2016-2017 SBC-EM Century Preferred PPO

    2016-2017 SBC-EM Century Preferred Comp Mix

    2016-2017 SBC-EM Lumenos HIA



     

     

     

     

     

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