Monthly Employee Contribution: Classified

CONTINUING FOR 2011-2012

Classified Employees receiving 10 checks per year will have their July and August employee contributions spread over their September through June paychecks. Be sure you reference the correct chart for your work schedule.

2011-12 Plan Year: 12 Checks Per Year

Effective 10/1/2011 - 09/30/2012

12 Checks Per Year: 7-8 hours ONLY
Classified Insurance Benefits: Medical, Prescription, Vision and Dental coverage	Plan 5	Plan 6	Plan 7	Plan 8
	$300 deductible	$400 deductible	$500 deductible	$1000 deductible
Employee Only	$115	$63	$20	$10
Employee + Spouse/Domestic Partner	$251	$138	$42	$21
Employee + Child(ren)	$218	$120	$37	$19
Employee + Spouse/Domestic Partner +Child(ren)	$354	$195	$60	$30

12 Checks Per Year: 6 to less than 7 hours ONLY
Classified Insurance Benefits: Medical, Prescription, Vision, AND DENTAL	Plan 5 $300 deductible	Plan 6 $400 deductible	Plan 7 $500 deductible	Plan 8 $1000 deductible
	With Dental	With Dental	With Dental	With Dental
Employee Only	$145	$93	$50	$40
Employee + Spouse/Domestic Partner	$314	$201	$105	$84
Employee + Child(ren)	$274	$176	$94	$75
Employee + Spouse/Domestic Partner +Child(ren)	$444	$285	$150	$120

12 Checks Per Year: 6 to less than 7 hours ONLY
Classified Insurance Benefits: Medical, Prescription, and Vision *NO DENTAL COVERAGE	Plan 5 $300 deductible	Plan 6 $400 deductible	Plan 7 $500 deductible	Plan 8 $1000 deductible
	No Dental	No Dental	No Dental	No Dental
Employee Only	$115	$63	$20	$10
Employee + Spouse/Domestic Partner	$251	$138	$42	$21
Employee + Child(ren)	$218	$120	$38	$19
Employee + Spouse/Domestic Partner +Child(ren)	$354	$195	$60	$30

12 Checks Per Year: 4 to less than 6 hours ONLY
Classified Insurance Benefits: Medical, Prescription, Vision, AND DENTAL	Plan 5 $300 deductible	Plan 6 $400 deductible	Plan 7 $500 deductible	Plan 8 $1000 deductible
	With Dental	With Dental	With Dental	With Dental
Employee Only	$178	$127	$83	$72
Employee + Spouse/ Domestic Partner	$384	$271	$175	$154
Employee + Child(ren)	$336	$239	$156	$137
Employee + Spouse/ Domestic Partner +Child(ren)	$544	$385	$250	$220

12 Checks Per Year: 4 to less than 6 hours ONLY
Classified Insurance Benefits: Medical, Prescription, and Vision *NO DENTAL COVERAGE	Plan 5 $300 deductible	Plan 6 $400 deductible	Plan 7 $500 deductible	Plan 8 $1000 deductible
	No Dental	No Dental	No Dental	With Dental
Employee Only	$148	$97	$53	$72
Employee + Spouse/ Domestic Partner	$321	$208	$112	$154
Employee + Child(ren)	$280	$183	$100	$137
Employee + Spouse/ Domestic Partner +Child(ren)	$454	$295	$160	$220

*If you are in this part-time category (4 to less than 6 hours per day), you have the option to waive dental coverage and thereby reduce your out-of-pocket insurance cost. Keep in mind, you may only waive dental coverage during annual enrollment (or upon initial eligibility) and you will not be able to re-enroll in dental coverage for the remainder of the plan year (the only exceptions to this are if your hours increase to 6 hours or greater or if you lose other dental coverage and provide proof of the loss within 31 days). Be aware of OEBB waiver rules: If you choose dental coverage at a future enrollment, your first year of dental coverage may be limited to preventive-only (cleaning, x-ray).

2011-12 Plan Year: 10 Checks Per Year