Rate
Matrix
2006 Renewal
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CITY CARE
BENEFITS MONTHLY RATE CHART |
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PLANS |
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HIGH OPTION |
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LOW OPTION |
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Sharp AC Plan; Age Based Rates: |
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Age* |
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EE |
EE/SP |
EE/CH |
EE/FAMILY |
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0-39 |
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$212.79 |
$446.51 |
$489.54 |
$723.26 |
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40-54 |
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$291.86 |
$612.79 |
$670.93 |
$991.86 |
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55+ |
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$439.54 |
$923.26 |
$1,010.47 |
$1,494.19 |
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Sharp AF Plan; Age Based Rates: |
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Age* |
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EE |
EE/SP |
EE/CH |
EE/FAMILY |
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0-39 |
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$194.19 |
$408.14 |
$446.51 |
$660.47 |
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40-54 |
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$268.61 |
$563.95 |
$617.44 |
$912.79 |
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55+ |
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$406.98 |
$854.65 |
$936.05 |
$1,383.72 |
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Golden West PPO Dental |
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RC1500 |
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RC1000 |
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Employee Only |
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$48.66 |
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$37.56 |
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Employee & Spouse |
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$98.38 |
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$75.75 |
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Employee & Child(ren) |
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$95.79 |
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$73.77 |
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Employee & Family |
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$145.50 |
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$111.96 |
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Golden West HMO Dental |
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89L3 |
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Employee Only |
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$14.58 |
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$11.01 |
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Employee & Spouse |
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$26.39 |
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$17.68 |
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Employee & Child(ren) |
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$28.27 |
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$16.74 |
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Employee & Family |
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$40.89 |
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$25.64 |
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Golden West Vol. Dental |
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PPO/MAC1000V |
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HMO/PCPV |
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Employee Only |
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$29.26 |
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$11.01 |
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Employee & Spouse |
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$58.77 |
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$17.68 |
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Employee & Child(ren) |
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$57.23 |
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$16.74 |
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Employee & Family |
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$86.73 |
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$25.64 |
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Golden West Vol. HMO Vision |
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90GE |
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Employee Only |
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$7.07 |
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Employee & Spouse |
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$13.29 |
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Employee & Child(ren) |
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$12.21 |
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Employee & Family |
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$20.25 |
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Safeguard Vision |
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I-31 |
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PIV |
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Employee Only |
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$9.72 |
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$6.04 |
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Employee & Spouse |
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$17.39 |
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$10.86 |
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Employee & Child(ren) |
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$16.50 |
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$10.26 |
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Employee & Family |
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$24.17 |
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$15.08 |
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American Specialty Health Plan** |
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Chiro Only |
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Chiro/Acu |
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Employee Only |
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$2.50 |
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$4.40 |
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Employee & Spouse |
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$5.00 |
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$8.80 |
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Employee & Child(ren) |
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$3.75 |
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$6.60 |
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Employee & Family |
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$7.25 |
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$11.45 |
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$20,000/EE Term Life & AD&D |
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