EMPLOYEE MONTHLY CONTRIBUTIONS 2010      
                             
             
             
    Option 1-CIGNA HMO  Option 2-CIGNA PPO  Option 3-CIGNA HDHP  Option 4-Kaiser Permanente HMO  
Full-time: Medical Dental M/D Medical Dental M/D Medical Dental M/D Medical Dental M/D  
Employee Only  $399  $11 $410 $364  $11 $375 $45  $11 $56 $85  $11 $96  
Employee Plus One  $790  $22 $812 $721  $22 $743 $90  $22 $112 $167  $22 $189  
Employee Plus Family  $1,105  $32 $1,137 $1,009  $32 $1,041 $135  $32 $167 $234  $32 $266  
   
  Option 1-CIGNA HMO  Option 2-CIGNA PPO  Option 3-CIGNA HDHP Option 4-Kaiser Permanente HMO  
Part-time: Medical Dental M/D Medical Dental M/D Medical Dental M/D Medical Dental M/D  
Employee  
Only  
.90  $429.00 $14.50 $443.50 $394.00 $14.50 $408.50 $84.20 $14.50 $98.70 $115.00 $14.50 $129.50  
.80  $459.00 $18.00 $477.00 $424.00 $18.00 $442.00 $123.40 $18.00 $141.40 $145.00 $18.00 $163.00  
.75  $474.00 $19.75 $493.75 $439.00 $19.75 $458.75 $143.00 $19.75 $162.75 $160.00 $19.75 $179.75  
.70  $489.00 $21.50 $510.50 $454.00 $21.50 $475.50 $162.60 $21.50 $184.10 $175.00 $21.50 $196.50  
.60  $519.00 $25.00 $544.00 $484.00 $25.00 $509.00 $201.80 $25.00 $226.80 $205.00 $25.00 $230.00  
.50  $549.00 $28.50 $577.50 $514.00 $28.50 $542.50 $241.00 $28.50 $269.50 $235.00 $28.50 $263.50  
.40  $579.00 $32.00 $611.00 $544.00 $32.00 $576.00 $280.20 $32.00 $312.20 $265.00 $32.00 $297.00  
.30  $609.00 $35.50 $644.50 $574.00 $35.50 $609.50 $319.40 $35.50 $354.90 $295.00 $35.50 $330.50  
.25  $624.00 $37.25 $661.25 $589.00 $37.25 $626.25 $339.00 $37.25 $376.25 $310.00 $37.25 $347.25  
.20  $639.00 $39.00 $678.00 $604.00 $39.00 $643.00 $358.60 $39.00 $397.60 $325.00 $39.00 $364.00  
   
  Option 1-CIGNA HMO  Option 2-CIGNA PPO  Option 3-CIGNA HDHP Option 4-Kaiser Permanente HMO  
Part-time: Medical Dental M/D Medical Dental M/D Medical Dental M/D Medical Dental M/D  
Employee  
Plus One   
.90  $849.40 $28.70 $878.10 $780.40 $28.70 $809.10 $167.50 $28.70 $196.20 $226.40 $28.70 $255.10  
.80  $908.80 $35.40 $944.20 $839.80 $35.40 $875.20 $245.00 $35.40 $280.40 $285.80 $35.40 $321.20  
.75  $938.50 $38.75 $977.25 $869.50 $38.75 $908.25 $283.75 $38.75 $322.50 $315.50 $38.75 $354.25  
.70  $968.20 $42.10 $1,010.30 $899.20 $42.10 $941.30 $322.50 $42.10 $364.60 $345.20 $42.10 $387.30  
.60  $1,027.60 $48.80 $1,076.40 $958.60 $48.80 $1,007.40 $400.00 $48.80 $448.80 $404.60 $48.80 $453.40  
.50  $1,087.00 $55.50 $1,142.50 $1,018.00 $55.50 $1,073.50 $477.50 $55.50 $533.00 $464.00 $55.50 $519.50  
.40  $1,146.40 $62.20 $1,208.60 $1,077.40 $62.20 $1,139.60 $555.00 $62.20 $617.20 $523.40 $62.20 $585.60  
.30  $1,205.80 $68.90 $1,274.70 $1,136.80 $68.90 $1,205.70 $632.50 $68.90 $701.40 $582.80 $68.90 $651.70  
.25  $1,235.50 $72.25 $1,307.75 $1,166.50 $72.25 $1,238.75 $671.25 $72.25 $743.50 $612.50 $72.25 $684.75  
.20  $1,265.20 $75.60 $1,340.80 $1,196.20 $75.60 $1,271.80 $710.00 $75.60 $785.60 $642.20 $75.60 $717.80  
   
  Option 1-CIGNA HMO  Option 2-CIGNA PPO  Option 3-CIGNA HDHP Option 4-Kaiser Permanente HMO  
Part-time: Medical Dental M/D Medical Dental M/D Medical Dental M/D Medical Dental M/D  
Employee Plus  
Family   
.90  $1,188.10 $42.10 $1,230.20 $1,092.10 $42.10 $1,134.20 $242.50 $42.10 $284.60 $317.10 $42.10 $359.20  
.80  $1,271.20 $52.20 $1,323.40 $1,176.20 $52.20 $1,227.40 $350.00 $52.20 $402.20 $400.20 $52.20 $452.40  
.75  $1,312.75 $57.25 $1,370.00 $1,216.75 $57.25 $1,274.00 $403.75 $57.25 $461.00 $441.75 $57.25 $499.00  
.70  $1,354.30 $62.30 $1,416.60 $1,258.30 $62.30 $1,320.60 $457.50 $62.30 $519.80 $483.30 $62.30 $545.60  
.60  $1,437.40 $72.40 $1,509.80 $1,341.40 $72.40 $1,413.80 $565.00 $72.40 $637.40 $566.40 $72.40 $638.80  
.50  $1,520.50 $82.50 $1,603.00 $1,424.50 $82.50 $1,507.00 $672.50 $82.50 $755.00 $649.50 $82.50 $732.00  
.40  $1,603.60 $92.60 $1,696.20 $1,507.60 $92.60 $1,600.20 $780.00 $92.60 $872.60 $732.60 $92.60 $825.20  
.30  $1,686.70 $102.70 $1,789.40 $1,590.70 $102.70 $1,693.40 $887.50 $102.70 $990.20 $815.70 $102.70 $918.40  
.25  $1,728.25 $107.75 $1,836.00 $1,632.25 $107.75 $1,740.00 $941.25 $107.75 $1,049.00 $857.25 $107.75 $965.00  
.20  $1,769.80 $112.80 $1,882.60 $1,673.80 $112.80 $1,786.60 $995.00 $112.80 $1,107.80 $898.80 $112.80 $1,011.60  
COBRA and Retirees under age 65 Monthly Rates  
  Option 1-CIGNA HMO Option 2-CIGNA PPO Option 3-CIGNA HDHP Option 4-Kaiser Permanente HMO  
COBRA (paid by COBRA beneficiary)  Medical Dental M/D Medical Dental M/D Medical  Dental  M/D  Medical Dental M/D  
Single Coverage  $668 $46 $714 $634 $46 $680 $417 $46 $463 $392 $46 $438  
Single plus one  $1,322 90 $1,413 $1,256 $90 $1,346 $826 $90 $916 $776 $90 $866  
Family  $1,850 $136 $1,986 $1,757 $136 $1,893 $1,156 $136 $1,292 $1,086 $136 $1,222  
To qualify as a UCAR Retiree, the employee must meet the formula of age (minimum 50) + Years of Service (minimum 5 years) = 65 or more and upon termination must formally indicate retirement as the reason for termination.