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    Department of Finance

    Medical Benefits

    Open Enrollment Period for Medical Benefits for City and Board of Education Employees.
    The Open Enrollment Period has ended.

    Read More HERE


    NEW STATE INSURANCE GUIDELINES FOR ADDING OR CHANGING DEPENDENTS

    Circumstances that are considered “Change of Life” and allow you to make additions of (to) dependents anytime throughout the year to your health plan are as follows:

    Marriage
    Birth of a child
    Adoption
    Assumption of legal guardianship or court ordered custody
    New step children
    Loss of coverage from another insurance carrier

    An Enrollment and Membership Change Form must be submitted to The Department of Human Resources and Medical Benefits within 31 days from the date of qualifying event. If it is not received in the 31 days, you will not be able to add your dependent until the next annual Open Enrollment. Forms are available at the Department of Human Resources and Medical Benefits at 200 Orange Street, or below with the corresponding Bargaining Unit information.

    Please see the Document Requirements list to review the necessary records.

    EMPLOYEE BENEFIT INFORMATION AND COST SHARES

    Local 18-School Administrators;
    Local 424-PW Laborers;
    Local 71-Blue Collar
    Locals 90 et al.-Tradesmen;
    Local 217-Cafeteria Food Service
    ;
    Local 287-Custodians

    Local 530-Police;
    Local 825-Fire
    ;
    Local 884-Clerical & Technical

    Local 933-Teachers;
    Local 1303-102-NH Child Development;
    Local 1303-464 - Attorneys
    Local 3144-Management & Professional;
    Local 3429-Paraprofessionals

    Executive & Confidential


    LOCAL 18 - SAA  Premium Cost Shares
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAY PERIOD DEDUCTIONS
    26 PAY PERIODS SINGLE 2 PERSON FAMILY
    High Deductible H.S.A.  12% 31.37 62.69 81.54
    Century Preferred Comp Mix  Buy-Up 86.46 181.55 232.74
    BlueCare POE  Buy-Up 141.08 290.77 374.73
    Century Preferred  PPO Buy-Up 151.22 311.06 401.10
    Full Pay Dental, ABCD 12% 1.90 4.93 6.86
           
    21 PAY PERIODS SINGLE 2 PERSON FAMILY
    High Deductible H.S.A.  12% 38.84 77.61 100.95
    Century Preferred Comp Mix  Buy-Up 107.05 224.78 288.16
    BlueCare POE  Buy-Up 174.67 360.01 463.96
    Century Preferred  PPO Buy-Up 187.23 385.13 496.60
    Full Pay Dental, ABCD 12% 2.35 6.11 8.50
     
    TERM LIFE
    as per contract NO COST TO EMPLOYEE

    Click on any of the below for more information:
    Local 18 - High Deductible Plan - Is it for me?
    Local 18 - How to use the Lumenos HSA
    Local 18 - Anthem's Lumenos HSA FAQ
    Local 18 Estimated Cost Shares FY 14-15

    Local 18 Medical Benefit Matrix New Plans
    Local 18 Prescription Drug Matrix
    Local 18 Dental Plan
    Local 18 Blue View Vision
    Local 18 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 18 - FAQs

    Local 18 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 18 Bluecare POE HMO

    2014 SBC – 18 Century Preferred PPO

    2014 SBC – 18 Comp Mix PPO

    2014 SBC – 18 Lumenos HIA

    Local 424-PW Laborers PREMIUM COST SHARES
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    CP2-2006 Century Preferred 17% 34.69 70.42 90.90
    BC1-2006 Bluecare POE 13% 26.27 53.33 68.84
    BC2-2006 Bluecare POE 11% 21.12 42.91 55.37
    Full Pay Dental, ABCD 17% 1.34 3.49 4.86
       
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee

    Local 424 - Enrollment and Membership Change Form


    "Click on any of the below for more information:
    Local 71 Premium Cost Shares, Effective April 1, 2014 - June 30, 2014
    Local 71 Medical Benefit Matrix New Plans 2013-2014
    Local 71 Health Incentive Account Lumenos HDHP
    Local 71 Prescription Drug Matrix
    Local 71 Dental Plan
    Local 71 Blue View Vision
    Local 71 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 71 - FAQs

    Local 71-Blue Collar PREMIUM COST SHARES
    FY 2014-2015 Effective  7/1/2014-3/31/2015
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 40.08 81.14 104.95
    Bluecare POE 19.25% 35.34 71.55 92.53
    Comp. Mix (CPCM) 15.25% 23.83 48.36 62.48
    Lumenos High Ded.  HIA 11.00% 14.25 28.47 62.48
    Full Pay Dental, ABCD 10.00% 0.79 2.06 2.86
       
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee

    Local 71 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 71 Bluecare POE HMO

    2014 SBC – 71 Century Preferred PPO

    2014 SBC – 71 Comp Mix PPO

    2014 SBC – 71 Lumenos HIA

    Local 90 et al.-Tradesmen PREMIUM COST SHARES
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    WEEKLY DEDUCTIONS
    COVERAGE % SINGLE 2 PERSON FAMILY
    CENTURY PREFERRED PPO 21.25% 40.08 81.14 104.95
    BLUECARE POE 17.00% 31.20 63.19 81.72
    COMP MIX (CPCM) 15.25% 23.83 48.36 62.48
    Lumenos High Ded.  HIA 11.00% 14.25 28.47 37.10
    BLUECARE 30 / 35 POE 13.50% 23.86 48.31 62.48
    DENTAL ABCD 10.00% 0.79 2.06 2.86
     
    TERM LIFE
    $25,000 per employee NO COST TO EMPLOYEE

    Trades click on any of the below for more information:
    Trades Premium Cost Shares, Effective February 1, 2014 - June 30, 2014
    Trades Medical Benefit Matrix New Plans 2013-2014
    Trades Health Incentive Account Lumenos HDHP
    Trades Prescription Drug Matrix
    Trades Dental Plan
    Trades Blue View Vision
    Trades Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Trades - FAQs

    Local Trades Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – Trades Bluecare POE HMO

    2014 SBC – Trades Century Preferred PPO

    2014 SBC – Trades Comp Mix PPO

    2014 SBC – Trades Lumenos HIA

    2014 SBC - Trades BC-1 POS


    LOCAL 217 Premium Cost Shares
    Cafeteria Food Service Effective School Year 2014-2015
    FY 2014-2015
    Effective  3/1/2014-12/31/2014
    PER PAY PERIOD DEDUCTIONS
    40 PAY PERIODS % SINGLE 2 PERSON FAMILY
    Unite Here Health Plan 10% 20.10 40.26 56.75
    Blue View Vision  12% 0.16 0.28 0.44
    Full Pay Dental, ABCD 12% 1.23 3.21 4.46
    Effective  1/1/2015-12/31/2015
    PER PAY PERIOD DEDUCTIONS
             
    40 PAY PERIODS % SINGLE 2 PERSON FAMILY
    Unite Here Health Plan 10% 21.91 43.88 61.86
    Blue View Vision  12% 0.16 0.28 0.44
    Full Pay Dental, ABCD 12% 1.23 3.21 4.46
       
    TERM LIFE NO COST TO EMPLOYEE
    $8,000 per employee

    Eligible members of Local 217 are offered Medical Benefit coverage through UNITE HERE, and are offered Dental / Vision through Anthem. Click on the below for more information:

    Local 217 - UNITE HERE Health Enrollment Packet
    Local 217 - Anthem Enrollment Form for Dental & Vision Coverage
    Local 217 - UNITE HERE HEALTH Summary Plan Description
    Local 217 - UNITE HERE SBC 2014 (Summary of Benefits and Coverage)


    LOCAL 287-Custodians PREMIUM COST SHARES
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    WEEKLY DEDUCTIONS
    COVERAGE % SINGLE 2 PERSON FAMILY
    BC2-BLUECARE POS 15% 29.08 58.98 76.16
    LUMENOS HDHP/HSA 15.49 30.98 39.94
    FABCD DENTAL 15% 1.19 3.08 4.29
     
    TERM LIFE
    $25,000 per employee NO COST TO EMPLOYEE

    Local 287 - Enrollment and Membership Change Form


    Local 530-Police PREMIUM COST SHARES
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    BC1-  POS 32% 65.20 131.86 170.61
    Century Preferred PPO 27% 50.93 103.10 133.34
    Bluecare POE 21% 38.55 78.06 100.94
    Cent Pref Comp Mix 17% 26.56 53.91 69.65
    Lumenos High Ded. HIA 14% 18.13 36.23 47.21
    Full Pay Dental ABCD 15% 1.19 3.08 4.29
       
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee

    Members of Local 530 - Click on any of the below for more information:
    Local 530 Premium Cost Shares, Effective June 1, 2013 - June 30, 2013 AND Effective July 1, 2013 - June 30, 2014
    Local 530 Medical Benefit Matrix New Plans 2013-2014
    Local 530 BC-1 POS Matrix
    Local 530 Health Incentive Account Lumenos HDHP
    Local 530 Prescription Drug Matrix
    Local 530 Dental Plan
    Local 530 Blue View Vision
    Local 530 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 530 New Plans - FAQs

    Local 530 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 530 Bluecare POE HMO

    2014 SBC – 530 Century Preferred PPO

    2014 SBC – 530 Comp Mix PPO

    2014 SBC – 530 Lumenos HIA

    2014 SBC - 530 BC-1 POS


    LOCAL 825-Fire Premium Cost Shares
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAYROLL  DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % Single 2 Person Family
    Century Preferred  PPO Buy-Up 66.53 137.69 177.15
    High Deductible H.S.A.  13.5% 19.70 39.37 51.21
    Full Pay Dental ABCD 13.5% 1.07 2.77 3.86
       
    TERM LIFE NO COST TO EMPLOYEE
    $15,000  per employee

    "Click on any of the below for more information:
    Local 825 Estimated Cost Shares FY 14-15
    Local 825 Medical Benefit Matrix New Plans
    Local 825 Prescription Drug Matrix
    Local 825 Dental Plan
    Local 825 Blue View Vision
    Local 825 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 825 - NEW PLAN Choices FAQs
    Local 825 - HDHP / HSA Frequently Asked Questions and Information


    Local 884 PREMIUM COST SHARES
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAYROLL DEDUCTIONS
    Paid 52 weeks 52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 40.08 81.14 104.95
    Bluecare POE 19.25% 35.34 71.55 92.53
    Comp. Mix 15.25% 23.83 48.36 62.48
    Lumenos High Ded.  HIA 11.00% 14.93 30.33 39.64
    Full Pay Dental, ABCD 10.00% 0.79 2.06 2.86
       
    Paid 42 weeks per year 42 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 49.63 100.46 129.93
    Bluecare POE 19.25% 43.75 88.59 114.56
    Comp. Mix 15.25% 29.50 59.87 77.35
    Lumenos High Ded.  HIA 11.00% 18.48 37.55 49.08
    Full Pay Dental, ABCD 10.00% 0.98 2.54 3.54
       
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 52.11 105.49 136.43
    Bluecare POE 19.25% 45.94 93.02 120.29
    Comp. Mix 15.25% 30.98 62.86 81.22
    Lumenos High Ded.  HIA 11.00% 19.41 39.43 51.54
    Full Pay Dental, ABCD 10.00% 1.03 2.67 3.72
       
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 80.17 162.29 209.89
    Bluecare POE 19.25% 70.67 143.11 185.06
    Comp. Mix 15.25% 47.66 96.71 124.95
    Lumenos High Ded.  HIA 11.00% 29.86 60.66 79.29
    Full Pay Dental, ABCD 10.00% 1.58 4.11 5.72
       
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 21.25% 99.26 200.93 259.87
    Bluecare POE 19.25% 87.50 177.18 229.13
    Comp. Mix 15.25% 59.00 119.74 154.71
    Lumenos High Ded.  HIA 11.00% 36.96 75.10 98.17
    Full Pay Dental, ABCD 10.00% 1.71 4.45 6.20
    TERM LIFE NO COST TO EMPLOYEE
    $20,000  per employee
       
    Local 884 Premium Cost Shares
    Local 884-PT PEO FULLY EQUIVALENT PREMIUM COSTS
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    MONTHLY COSTS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 100% 847.28 1736.08 2251.75
    Bluecare POE 100% 825.30 1692.12 2194.62
    Comp. Mix 100% 677.09 1374.07 1775.31
    Lumenos High Ded.  HIA 100% 561.29 1121.49 1461.33
    Full Pay Dental, ABCD 100% 34.25 89.05 123.90
     
    PLEASE NOTE THAT MONTHLY COSTS WILL CHANGE EVERY JULY 1ST.
    MONTHLY PAYMENTS ARE DUE BY THE 1st OF THE MONTH OF COVERAGE.
    CHECKS ARE MADE PAYABLE TO "TREASURER-CITY OF NEW HAVEN"
    AND BROUGHT OR MAILED TO THE MEDICAL BENEFITS DIVISION,
    1ST FLOOR, 200 ORANGE STREET, NEW HAVEN, CT 06510.

    Members of Local 884 - Click on any of the below for more information
    Local 884 Premium Cost Shares,
    Effective 11/1/2012-6/30/2012
    Local 884 Medical Benefit Matrix 2012-2013
    Local 884 Health Incentive Account Lumenos HDHP
    Local 884 Dental Plan
    Local 884 Blue View Vision
    Local 884 Enrollment and Membership Change Form

    Local 884 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 884 Bluecare POE HMO

    2014 SBC – 884 Century Preferred PPO

    2014 SBC – 884 Comp Mix PPO

    2014 SBC – 884 Lumenos HIA


    LOCAL 933-Teachers Premium Cost Shares
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    Effective School Year 2014-2015
    PAY PERIOD DEDUCTIONS
    21 PAY PERIODS % SINGLE 2 PERSON FAMILY
    Century Preferred  PPO 22.0% 103.06 208.67 269.85
    BlueCare POE  18.0% 82.06 166.20 214.91
    Century Preferred Comp Mix  13.0% 50.48 102.46 132.36
    High Deductible H.S.A.  12.0% 38.84 77.61 100.95
    Full Pay Dental-2010 ABCD 15.0% 3.11 8.09 11.52
     
    TERM LIFE
    $75,000 PER EMPLOYEE NO COST TO EMPLOYEE

    Local 933 - High Deductible Plan - Is it for me?
    Local 933 - How to use the Lumenos HSA
    Local 933 - Anthem's Lumenos HSA FAQ
    Local 933 Estimated Cost Shares FY 14-15

    Local 933 Medical Benefit Matrix New Plans
    Local 933 Prescription Drug Matrix
    Local 933 Dental Plan
    Local 933 Blue View Vision
    Local 933 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 933 - FAQs

    Local 933 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 933 Bluecare POE HMO

    2014 SBC – 933 Century Preferred PPO

    2014 SBC – 933 Comp Mix PPO

    2014 SBC – 933 Lumenos HIA

    Medical Benefit Waiver / Opt-Out Program
    As noted in your new contract, only those Teachers who receive a Medical Benefit Opt Out payment for the 2013-14 school year will be eligible for this payment in the 2014-15 school year and beyond.
    Those eligible Teachers will receive information regarding the Re-Enrollment process by mail. Click HERE to download a pdf of the Waiver / Opt-Out Form.


    Local 3144-Management PREMIUM COST SHARES
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAYROLL DEDUCTIONS
    Paid 52 weeks per year 52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 43.39 87.83 113.59
     Bluecare POE 21.0% 38.55 78.06 100.94
    Comp. Mix 17.0% 26.56 53.91 69.65
    Lumenos High Ded.  HIA 12.0% 14.90 29.77 38.72
    Full Pay Dental, ABCD 15.0% 1.19 3.08 4.29
       
    Paid 40 weeks per year 40 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 56.40 114.17 147.67
     Bluecare POE 21.0% 50.11 101.48 131.23
    Comp. Mix 17.0% 34.53 70.08 90.54
    Lumenos High Ded.  HIA 12.0% 19.37 38.70 50.34
    Full Pay Dental, ABCD 15.0% 1.54 4.01 5.58
       
    Paid 26 weeks per year 26 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 86.77 175.65 227.18
     Bluecare POE 21.0% 77.09 156.12 201.89
    Comp. Mix 17.0% 53.13 107.81 139.29
    Lumenos High Ded.  HIA 12.0% 29.80 59.54 77.44
    Full Pay Dental, ABCD 15.0% 2.37 6.17 8.58
       
    Paid 21 weeks per year 21 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 107.43 217.47 281.27
     Bluecare POE 21.0% 95.45 193.29 249.96
    Comp. Mix 17.0% 65.77 133.48 172.46
    Lumenos High Ded.  HIA 12.0% 36.89 73.71 95.88
    Full Pay Dental, ABCD 15.0% 2.94 7.63 10.62
     
    TERM LIFE
    $20,000 per employee NO COST TO EMPLOYEE

    Local 3144/Executive Management - Click on any of the below for more information:
    Local 3144 / Executive Management Premium Cost Shares, Effective November, 2013 - June 30, 2013
    Local 3144 / Executive Management Medical Benefit Matrix New Plans 2013-2014
    Local 3144 / Executive Management Health Incentive Account Lumenos HDHP
    Local 3144 / Executive Management Prescription Drug Matrix
    Local 3144 / Executive Management Dental Plan
    Local 3144 / Executive Management Blue View Vision
    Local 3144 / Executive Management Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 3144 New Plans - FAQs

    Local 3144 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 3144 Bluecare POE HMO

    2014 SBC – 3144 Century Preferred PPO

    2014 SBC – 3144 Comp Mix PPO

    2014 SBC – 3144 Lumenos HIA


    LOCAL 3429 Premium Cost Shares
    Paraprofessionals Effective School Year 2014-2015
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAY PERIOD DEDUCTIONS
    21 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 20.25% 94.58 191.47 247.64
    Bluecare POE 18.25% 82.95 167.98 217.22
    Cent Pref Comp Mix 14.25% 55.13 111.89 144.56
    Lumenos High Ded. HIA 7.00% 28.87 57.68 75.15
    Full Pay Dental ABCD 10.00% 1.96 5.09 7.08
       
    TERM LIFE NO COST TO EMPLOYEE
    $25,000 per employee

    Members of Local 3429 - Click on any of the below for more information:
    Local 3429 Premium Cost Shares, Effective May 1, 2013 - June 30, 2013 AND Effective July 1, 2013 - June 30, 2014
    Local 3429 Medical Benefit Matrix 2013-2014
    Local 3429 Health Incentive Account Lumenos HDHP
    Local 3429 Prescription Comparison
    Local 3429 Dental Plan
    Local 3429 Blue View Vision
    Local 3429 Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 3429 New Plans - FAQs

    Local 3429 Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – 3429 Bluecare POE HMO

    2014 SBC – 3429 Century Preferred PPO

    2014 SBC – 3429 Comp Mix PPO

    2014 SBC – 3429 Lumenos HIA


    LOCAL 1303-102 PREMIUM COST SHARES
    NH CHILD DEVELOPMENT
    FY 2013-2014 Effective  7/1/2013-6/30/2014
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % Single 2 Person Family
    BC1-1303-102 Bluecare POE 12% 22.17 44.95 58.06
    BC2-1303-102 Bluecare POE 10% 17.53 35.58 45.94
    Full Pay Dental ABCD 12% 0.92 2.38 3.31

    Executive & Confidential PREMIUM COST SHARES
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % SINGLE 2 PERSON FAMILY
    Century Preferred PPO 23.0% 43.39 87.83 113.59
     Bluecare POE 21.0% 38.55 78.06 100.94
    Comp. Mix 17.0% 26.56 53.91 69.65
    Lumenos High Ded.  HIA 12.0% 14.90 29.77 38.72
    Full Pay Dental, ABCD 15.0% 1.19 3.08 4.29
    PAYROLL DEDUCTIONS
    26 PAY PERIODS
    COVERAGE % Single 2 Person Family
    Century Preferred PPO 23.0% 86.77 175.65 227.18
     Bluecare POE 21.0% 77.09 156.12 201.89
    Comp. Mix 17.0% 53.13 107.81 139.29
    Lumenos High Ded.  HIA 12.0% 29.80 59.54 77.44
    Full Pay Dental, ABCD 15.0% 2.37 6.17 8.58
         
    TERM LIFE 20,000 NO COST TO EMPLOYEE
    if salary over $50,000 100,000 NO COST TO EMPLOYEE

    Local 3144/Executive Management - Click on any of the below for more information:
    Local 3144 / Executive Management Premium Cost Shares, Effective November, 2013 - June 30, 2013
    Local 3144 / Executive Management Medical Benefit Matrix New Plans 2013-2014
    Local 3144 / Executive Management Health Incentive Account Lumenos HDHP
    Local 3144 / Executive Management Prescription Drug Matrix
    Local 3144 / Executive Management Dental Plan
    Local 3144 / Executive Management Blue View Vision
    Local 3144 / Executive Management Enrollment and Membership Change Form
    Re-Enrollment Document Requirements
    Local 3144 New Plans - FAQs

    Executive Management Summary of Benefits and Coverage (SBC) by plan

    2014 SBC – EM Bluecare POE HMO

    2014 SBC – EM Century Preferred PPO

    2014 SBC – EM Comp Mix PPO

    2014 SBC – EM Lumenos HIA


    LOCAL 1303-464 PREMIUM COST SHARES
    Corporation Counsel
    FY 2014-2015 Effective  7/1/2014-6/30/2015
    PAYROLL DEDUCTIONS
    52 PAY PERIODS
    COVERAGE % Single 2 Person Family
    CP2- Century Preferred 24% 51.03 103.65 133.75
    BC1-1303-464 Bluecare    $5/$10 18% 38.44 78.07 100.75
    BC2-1303-464 Bluecare $15$/$25 16% 32.25 65.57 84.58
    Full Pay Dental ABCD 24% 1.90 4.93 6.86
         
    TERM LIFE 20,000 NO COST TO EMPLOYEE
    if salary over $50,000 100,000 NO COST TO EMPLOYEE

    Local 1303-464 - Enrollment and Membership Change Form


     

     

     

     

     

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