|
GENERAL RETIREE PLAN DESIGN ESCALATION
@ MITIGATED LEVELS
|
|
MEDICAL
ESCALATION @
|
7 %
|
7 %
|
7 %
|
7 %
|
7 %
|
|
Effective annual dates
|
2007
|
2008
|
2009
|
20010
|
2011
|
|
|
US $
|
US $
|
US $
|
US $
|
US $
|
|
MONTHLY CONTRIBUTIONS **
|
|
|
|
|
|
|
Single
|
10
|
11
|
11
|
12
|
13
|
|
Family
|
21
|
22
|
24
|
26
|
28
|
|
MEDICAL PLAN
|
|
|
|
|
|
|
Deductible single
|
150
|
161
|
172
|
184
|
197
|
|
Deductible family
|
300
|
321
|
343
|
368
|
393
|
|
Co insurance in network
|
10%
|
10%
|
10%
|
10%
|
10%
|
|
Co insurance out of network
|
30%
|
30%
|
30%
|
30%
|
30%
|
|
MOOP Single in network
MOOP means:
"Money out of your pocket"
|
250
|
268
|
286
|
306
|
328
|
|
MOOP Family in network
|
500
|
535
|
572
|
613
|
655
|
|
MOOP Single out of network
|
500
|
535
|
572
|
613
|
655
|
|
MOOP Family out of network
|
1000
|
1070
|
1145
|
1225
|
1311
|
|
|
|
|
|
|
|
|
Emergency Room Copay **
|
50
|
54
|
57
|
61
|
66
|
|
|
|
|
|
|
|
|
RX Escalation @
|
7 %
|
7 %
|
7 %
|
7 %
|
7 %
|
|
|
|
|
|
|
|
|
RX Plan **
|
|
|
|
|
|
|
Generic Retail
|
7
|
7
|
8
|
9
|
9
|
|
Brand Retail
|
12
|
13
|
14
|
15
|
16
|
|
ED Meds Retail
|
15
|
16
|
17
|
18
|
20
|
|
Generic Mail
|
14
|
15
|
16
|
17
|
18
|
|
Brand Mail
|
22
|
24
|
25
|
27
|
29
|
|
ED Meds Retail
|
22
|
24
|
25
|
27
|
29
|
|
Not subject to deductible or out of pocket maximum
|
|
PROTECTED RETIREE CO PAYS
|
|
Generic Retail
|
5
|
5
|
5
|
5
|
5
|
|
Brand Retail
|
10
|
10
|
10
|
10
|
10
|
|
ED Meds Retail
|
15
|
15
|
15
|
15
|
15
|
|
Generic Mail
|
10
|
10
|
10
|
10
|
10
|
|
Brand Mail
|
15
|
15
|
15
|
15
|
15
|
|
ED Meds Mail Order
|
18
|
18
|
18
|
18
|
18
|
