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    Department of Finance

    Medical Benefits

    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

    NEW STATE INSURANCE GUIDELINES FOR ADDING OR CHANGING DEPENDENTS

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

    1. Marriage
    2. Birth of a child
    3. Adoption
    4. Assumption of legal guardianship or court ordered custody
    5. New step children
    6. Loss of coverage from another insurance carrier

    An application must be submitted to 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 open enrollment

    LOCAL 18 - SAA  Premium Cost Shares
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    PAY PERIOD DEDUCTIONS
    26 PAY PERIODS
    SINGLE
    2 PERSON
    FAMILY
    HSA Eligible/HDHP (vision+dental) 0 0 0
    Century Preferred Mix (vision+dental) 46.83 100.65 126.47
    BlueCare POE (vision+dental) 92.70 192.39 245.73
    Century Preferred (vision+dental) 102.60 212.19 271.47
    21 PAY PERIODS
    SINGLE
    2 PERSON
    FAMILY
    HSA Eligible/HDHP (vision+dental) 0 0 0
    Century Preferred Mix (vision+dental) 57.98 124.61 156.58
    BlueCare POE (vision+dental) 114.77 238.19 304.24
    Century Preferred (vision+dental) 127.03 262.71 336.11
    TERM LIFE
    as per contract NO COST TO EMPLOYEE
    Local 424-PW Laborers PREMIUM COST SHARES
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 17% 29.07 58.89 76.09
    BC1-2006 Bluecare POE 13% 21.91 44.40 57.36
    BC2-2006 Bluecare POE 11% 17.75 35.99 46.49
    Full Pay Dental, ABCD 17% 1.37 3.56 4.96
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
    Local 71-Blue Collar PREMIUM COST SHARES
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 17% 29.07 58.89 76.09
    BC1-2006 Bluecare POE 13% 21.91 44.40 57.36
    BC2-2006 Bluecare POE 11% 17.75 35.99 46.49
    Full Pay Dental, ABCD 17% 1.37 3.56 4.96
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
    Local 90 et al.-Tradesmen PREMIUM COST SHARES
    FY 2011-2012 Effective 7/1/2011-6/30/2012
    WEEKLY DEDUCTIONS
    SINGLE
    2 PERSON
    FAMILY
    BC1-BLUECARE POS 11%
    18.30
    37.00
    47.85
    BC2-BLUECARE POS 9%
    14.30
    28.93
    37.40
    CPCM-2010 Cent Pref Comp Mix 9%
    13.40
    27.13
    35.07
    FABCD DENTAL 11%
    0.89
    2.31
    3.21
    TERM LIFE
    $25,000 per employee NO COST TO EMPLOYEE
    LOCAL 217 Premium Cost Shares
    Cafeteria Food Service Effective School Year 2011-2012
    FY 2011-2012
    PER PAY PERIOD DEDUCTIONS
    40 PAY PERIODS
    SINGLE
    2 PERSON
    FAMILY
    BC1-217  Bluecare POE 12% 26.29 53.28 68.83
    BC2-217  Bluecare POE 10% 20.98 42.53 54.94
    Full Pay Dental, ABCD 12% 1.26 3.27 4.55
    TERM LIFE NO COST TO EMPLOYEE
    $8,000 per employee
    LOCAL 287-Custodians PREMIUM COST SHARES
    FY 2011-2012 Effective 7/1/2011-6/30/2012
    WEEKLY DEDUCTIONS
    SINGLE
    2 PERSON
    FAMILY
    BC1-BLUECARE POS 12%
    21.05
    42.68
    55.13
    BC2-BLUECARE POS 10%
    16.71
    33.90
    43.77
    FABCD DENTAL 12%
    0.97
    2.52
    3.50
    TERM LIFE
    $25,000 per employee NO COST TO EMPLOYEE
    Local 530-Police PREMIUM COST SHARES
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    BC1-Bluecare POS 12%
    21.05
    42.68
    55.13
    BC2-Bluecare POS 10%
    16.71
    33.90
    43.77
    CPCM-Cent Pref Comp 10%
    15.53
    31.54
    40.70
    Full Pay Dental ABCD 12%
    0.97
    2.52
    3.50
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee
    LOCAL 825-Fire Premium Cost Shares
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    PAYROLL  DEDUCTIONS
    52 PAY PERIODS
    COVERAGE %
    Single
    2 Person
    Family
    CP2-825 Century Preferred 16.5%
    28.69
    58.19
    75.14
    BC1-825 Bluecare POE 12.5%
    21.53
    43.66
    56.38
    BC2-825 Bluecare POE 10.5%
    17.26
    35.04
    45.23
    Full Pay Dental ABCD 16.5%
    1.33
    3.46
    4.81
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee
    LOCAL 825 FIRE -- HIRED SINCE January 1, 2006
    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%
    21.53
    61.12
    78.93
    BC2-825 Bluecare POE 10.5, 16.5%
    17.26
    55.06
    71.08
    Full Pay Dental ABCD 16.5%
    1.33
    3.46
    4.81
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee
    Local 884 PREMIUM COST SHARES
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    PAYROLL DEDUCTIONS
    Paid 52 weeks 52 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 17%
    29.07
    58.89
    76.09
    BC1-2006 Bluecare POE 13%
    21.91
    44.40
    57.36
    BC2-2006 Bluecare POE 11%
    17.75
    35.99
    46.49
    Full Pay Dental, ABCD 17%
    1.37
    3.56
    4.96
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 17% 37.79 76.56 98.92
    BC1-2006 Bluecare POE 13% 28.49 57.72 74.57
    BC2-2006 Bluecare POE 11% 23.08 46.78 60.43
    Full Pay Dental, ABCD 17% 1.78 4.63 6.45
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 17% 58.14 117.78 152.19
    BC1-2006 Bluecare POE 13% 43.82 88.80 114.72
    BC2-2006 Bluecare POE 11% 35.50 71.98 92.97
    Full Pay Dental, ABCD 17% 2.74 7.13 9.92
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 17% 71.98 145.82 188.42
    BC1-2006 Bluecare POE 13% 54.26 109.94 142.04
    BC2-2006 Bluecare POE 11% 43.96 89.11 115.11
    Full Pay Dental, ABCD 17% 3.39 8.82 12.28
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
    Local 884 PREMIUM COST SHARES
    FY 2008-2009 Effective  7/1/2008-6/30/2009
    Paid 42 weeks per year 42 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 17% 35.99 72.91 94.21
    BC1-2006 Bluecare POE 13% 27.13 54.97 71.02
    BC2-2006 Bluecare POE 11% 21.98 44.56 57.55
    Full Pay Dental, ABCD 17% 1.70 4.41 6.14
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee

    Local 884-PT PEO FULLY EQUIVALENT PREMIUM COSTS
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    MONTHLY COSTS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-2006 Century Preferred 100% 741.00 1,501.11 1,939.64
    BC1-2006 Bluecare POE 100% 730.39 1,479.92 1,912.07
    BC2-2006 Bluecare POE 100% 699.31 1,417.71 1,831.23
    Full Pay Dental, ABCD 100% 34.93 90.83 126.39
    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.
    LOCAL 933-Teachers Premium Cost Shares
    FY 2011-2012 Effective School Year 2011-2012
    PAY PERIOD DEDUCTIONS
    21 PAY PERIODS
    SINGLE
    2 PERSON
    FAMILY
    CP2-2010 Century Preferred 20.5% 84.32 170.55 220.56
    BC1-2010 Bluecare POE 16.5% 66.70 134.93 174.49
    CPCM-2010 Cent Pref Comp Mix 9.5% 35.08 71.04 91.81
    Full Pay Dental-2010 ABCD 20.5% 4.09 10.64 14.81
    TERM LIFE
    $55,000 PER EMPLOYEE NO COST TO EMPLOYEE
    Local 3144-Management PREMIUM COST SHARES
    FY 2011-2012 Effective  7/1/2011-6/30/2012
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-Century Preferred 18% 31.34 63.47 82.01
    BC1-Bluecare POS 14% 24.23 49.07 63.42
    BC2-Bluecare POS 12% 19.77 40.07 51.76
    Full Pay Dental, ABCD 18% 1.45 3.77 5.25
    26 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-Century Preferred 18% 62.67 126.93 164.03
    BC1-Bluecare POS 14% 48.46 98.15 126.83
    BC2-Bluecare POS 12% 39.54 80.13 103.52
    Full Pay Dental, ABCD 18% 2.90 7.55 10.50
    21 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-Century Preferred 18% 77.59 157.15 203.08
    BC1-Bluecare POS 14% 59.99 121.52 157.03
    BC2-Bluecare POS 12% 48.95 99.21 128.16
    Full Pay Dental, ABCD 18% 3.59 9.34 13.00
    TERM LIFE
    $20,000 per employee NO COST TO EMPLOYEE
    LOCAL 3429 Premium Cost Shares
    Paraprofessionals Effective School Year 2011-2012
    FY 2011-2012
    PER PAY PERIOD DEDUCTIONS
    21 PAY PERIODS
    SINGLE
    2 PERSON
    FAMILY
    BC1-2007 Bluecare POE 12% 50.08 101.48 131.11
    BC2-2007Bluecare POE 10% 39.96 81.01 104.64
    Full Pay Dental, ABCD 12% 2.40 6.23 8.67
    TERM LIFE NO COST TO EMPLOYEE
    $25,000 per employee
    LOCAL 1303-102 PREMIUM COST SHARES
    NH CHILD DEVELOPMENT Effective 7/1/2011-6/30/2012
    FY 2011-2012
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE %
    Single
    2 Person
    Family
    BC1-1303-102 Bluecare POE 12% 20.23 40.98 52.95
    BC2-1303-102 Bluecare POE 10% 16.14 32.72 42.26
    Full Pay Dental ABCD 12% 0.97 2.52 3.50
    Executive & Confidential PREMIUM COST SHARES
    FY 2011-2012      Effective  7/1/2010-6/30/2011
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE %
    SINGLE
    2 PERSON
    FAMILY
    CP2-Century Preferred 24% 42.35 85.85 110.89
    BC1-Bluecare POS 18% 31.58 64.02 82.69
    BC2-Bluecare POS 16% 26.74 54.24 70.04
    Full Pay Dental, ABCD 24% 1.93 5.03 7.00
    PAYROLL DEDUCTIONS
    26 PAY PERIODS
    COVERAGE %
    Single
    2 Person
    Family
    CP2-Century Preferred 24% 84.70 171.70 221.79
    BC1-Bluecare POS 18% 63.16 128.03 165.38
    BC2-Bluecare POS 16% 53.48 108.48 140.08
    Full Pay Dental, ABCD 24% 3.87 10.06 14.00
    TERM LIFE 20,000
    NO COST TO EMPLOYEE
    if salary over $50,000 100,000
    NO COST TO EMPLOYEE

     
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