City Care Benefits Monthly Rate Matrix

2006 Renewal

PLANS
Sharp High Option AC Plan; Age Based Rates:*
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 Low Option AF Plan; Age Based Rates:*
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 L11 Plan ($30 OV; 30% IH RX 20/35/70); Age Based Rates:*
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
	HIGH OPTION			LOW OPTION
Golden West PPO Dental	RC1500			RC1000
Employee Only	$52.06			$40.19
Employee & Spouse	$105.26			$81.05
Employee & Child(ren)	$102.49			$78.94
Employee & Family	$155.69			$119.80
Golden West HMO Dental	89L3			PCP
Employee Only	$14.58			$10.46
Employee & Spouse	$26.39			$16.80
Employee & Child(ren)	$28.27			$15.90
Employee & Family	$40.89			$24.36
Golden West Vol. Dental	PPO/MAC1000V			HMO/PCPV
Employee Only	$30.29			$10.46
Employee & Spouse	$60.83			$16.80
Employee & Child(ren)	$59.23			$15.91
Employee & Family	$89.76			$24.36
Golden West Vol. HMO Vision				90GE
Employee Only				$7.07
Employee & Spouse				$13.29
Employee & Child(ren)				$12.21
Employee & Family				$20.25
Safeguard Vision	I-31			PIV
Employee Only	$9.71			$6.05
Employee & Spouse	$17.41			$10.86
Employee & Child(ren)	$16.49			$10.27
Employee & Family	$24.18			$15.08