medical contributions (slide 1 of 2) plancoverage category base salary under $50,000 $50,000-...
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Medical Contributions(Slide 1 of 2)
Plan Coverage Category
Base SalaryUnder
$50,000$50,000-$74,999
$75,000-$124,999
$125,000+
2010 2011 2010 2011 2010 2011 2010 2011
UHC Value
Employee $10 $11 $38 $42 $66 $73 $89 $98
Employee + Spouse/Domestic Partner
$90 $99 $137 $151 $197 $217 $269 $296
Employee + Child(ren) $82 $90 $125 $138 $180 $198 $244 $268
Employee+ Spouse/Domestic Partner + Child(ren)
$130 $143 $197 $217 $283 $311 $385 $424
UHC Advantage
Employee $29 $32 $57 $63 $85 $94 $107 $118
Employee + Spouse/Domestic Partner
$131 $144 $178 $196 $238 $262 $310 $341
Employee + Child(ren) $119 $131 $162 $178 $216 $238 $280 $308
Employee+ Spouse/Domestic Partner + Child(ren)
$187 $206 $255 $281 $340 $374 $442 $486
Plan Coverage Category
Base SalaryUnder
$50,000$50,000-$74,999
$75,000-$124,999
$125,000+
2010 2011 2010 2011 2010 2011 2010 2011
Aetna HMO
Employee $53 $58 $81 $89 $110 $121 $132 $145
Employee + Spouse/Domestic Partner
$182 $200 $229 $252 $289 $318 $361 $397
Employee + Child(ren) $165 $182 $208 $229 $263 $289 $327 $360
Employee+ Spouse/Domestic Partner + Child(ren)
$260 $286 $328 $361 $413 $454 $515 $567
Oxford Freedom
HMO
Employee $73 $80 $101 $111 $130 $143 $152 $167
Employee + Spouse/Domestic Partner
$224 $246 $272 $299 $331 $364 $403 $443
Employee + Child(ren) $203 $223 $246 $271 $300 $330 $365 $402
Employee+ Spouse/Domestic Partner + Child(ren)
$320 $352 $388 $427 $473 $520 $575 $633
Medical Contributions(Slide 2 of 2)
Medical Plan Deductible
Medical Plan Current DeductibleDeductible
Effective January 1, 2011
In Network Out of Network In Network Out of Network
UHC Value: Individual $400 $2,500 $500 $2,600
UHC Value: Family $800 $5,000 $1,000 $5,200
UHC Advantage: Individual $300 $2,500 $400 $2,600
UHC Advantage: Family $600 $5,000 $800 $5,200
Aetna HMO: Individual $100 n/a $200 n/a
Aetna HMO: Family $200 n/a $400 n/a
Oxford HMO: Individual $100 n/a $200 n/a
Oxford HMO: Family $200 n/a $400 n/a
Type of PrescriptionCurrent Copays
CopaysEffective January 1, 2011
Purchased at Retail 30-day supply 30-day supply
Retail Generic $5 $10
Brand-name on CVS/Caremark’s Preferred Drug List $20 $35
Brand-name not on CVS/Caremark’s Preferred Drug List $35 $55
Mail Order 90-day supply 90-day supply
Mail Order Generic $10 $5
Brand-name on CVS/Caremark’s Preferred Drug List $40 $75
Brand-name not on CVS/Caremark’s Preferred Drug List $60 $90
Prescription Copays
Medical Plan Copays
Medical PlanCurrentCopay
Copay Effective January 1, 2011
UHC Value: PCP $20 $30
UHC Value: Specialist $30 $40
UHC Advantage: PCP $20 $30
UHC Advantage: Specialist $30 $40
Aetna HMO: PCP $20 $30
Aetna HMO: Specialist $30 $40
Oxford HMO: PCP $20 $30
Oxford HMO: Specialist $30 $40
Dental Plan Contributions Current Monthly RatesRates
Effective January 1, 2011
Employee Only $10 $10
Employee + Spouse/Domestic Partner $ 37 $ 37
Employee + Child(ren) $ 35 $ 35
Employee + Spouse/Domestic Partner + Child(ren)
$ 49 $ 49
Vision Plan Contributions Current Monthly RatesRates
Effective January 1, 2011
Employee Only $6.84 $6.84
Employee + One $14.43 $14.43
Employee + Family $23.24 $23.24
Vision and Dental