City Care Benefits Medical Plan Summary

2006 Renewal

SHARP HMO HEALTH PLAN AC (HIGH OPTION)

· No Deductibles

· $15 Physician and Other Professional Services Office Visit Copayment

· Inpatient and Outpatient Hospital Services Covered in Full

· $50 Emergency Room Copayment (waived if admitted to hospital)

· Prescription Drug Coverage

o Generic Drugs - $20 Copayment/30-day Supply

o Brand Formulary Drugs - $35 Copayment/30-day Supply

o Non-Formulary Drugs - $70 Copayment/30-day Supply

o 90-day mail order Generic Drugs - $40 Copayment

o 90-day mail order Brand Formulary Drugs - $70 Copayment

o 90-day mail order Non-Formulary Drugs - $140 Copayment

Monthly Age-Banded Premiums:

Age * EE EE/SP EE/CH EE/FAMILY

0-39 $220.45 $ 500.00 $ 480.68 $ 772.73

40-54 $367.05 $ 732.95 $ 578.41 $ 979.55

55+ $660.23 $1,332.95 $ 845.45 $1,521.59

SHARP HMO HEALTH PLAN AF (LOW OPTION)

· No Deductibles

· $40 Physician, same day laboratory and radiology service and Other Professional Services Office Visit Copayment

· Inpatient Hospital Services Covered in Full after a $250 Copayment per Admission

· Outpatient Surgery Services Covered in Full after a $125 Copayment per procedure

· $75 Emergency Room Copayment (waived if admitted to hospital)

· Prescription Drug Coverage

o Generic Drugs - $20 Copayment/30-day Supply

o Brand Formulary Drugs - $35 Copayment/30-day Supply

o Non-Formulary Drugs - $70 Copayment/30-day Supply

o 90-day mail order Generic Drugs - $40 Copayment

o 90-day mail order Brand Formulary Drugs - $70 Copayment

o 90-day mail order Non-Formulary Drugs - $140 Copayment

Monthly Age-Banded Premiums:

Age * EE EE/SP EE/CH EE/FAMILY

0-39 $205.68 $ 465.91 $447.73 $ 718.18

40-54 $342.05 $ 680.68 $537.50 $ 910.23

55+ $613.64 $1,238.64 $786.36 $1,414.77

SHARP HMO HEALTH PLAN L-11

· No Deductibles

· $30 Primary Care Physician and Specialist Physician office visit copayment

· Well child (to age 2) physical exams, periodic immunizations & related lab services covered in full

· Prenatal and postpartum office visits covered in full

· Inpatient Hospital Services Covered at 30% of Contracted Rate

· Radiology, pathology, hemodialysis, etc. covered in full

· Outpatient Hospital Services Covered at $1,500 per Procedure / $30 per visit for Physical, occupational & speech therapy

· $75 Emergency Room Copayment (waived if admitted to hospital)

· Prescription Drug Coverage

o Generic Drugs - $20 Copayment/30-day Supply

o Brand Formulary Drugs - $35 Copayment/30-day Supply

o Non-Formulary Drugs - $70 Copayment/30-day Supply

o 90-day mail order Generic Drugs - $40 Copayment

o 90-day mail order Brand Formulary Drugs - $70 Copayment

o 90-day mail order Non-Formulary Drugs - $140 Copayment

Monthly Age-Banded Premiums:

Age * EE EE/SP EE/CH EE/FAMILY

0-29 $192.05 $ 445.46 $ 417.05 $ 672.73

30-39 $222.73 $ 495.46 $ 489.77 $ 782.96

40-49 $314.77 $ 636.36 $ 545.46 $ 901.14

50-54 $395.46 $ 782.96 $ 573.86 $ 994.32

55-59 $492.05 $ 987.50 $ 654.55 $1,177.27

60-64 $611.36 $1,236.36 $ 767.05 $1,407.96

65+ $804.55 $1,623.86 $1,020.46 $1,809.09

NOTE:

1. HMO Medical Plan Rates are Guaranteed to August 1, 2007.

2. HMO Plans Will Cover 2+ Eligible Employee Groups.

3. Multiple-choice HMO Plans are NOW Available.

* When an employee's age changes from one age bracket to another, the rate will increase effective the first of the month following the date of the change.

NOTE: City Care Benefits plan descriptions provide a brief summary of the benefits only and are not complete regarding all the provisions of the plans, including limitations and exclusions.