2021 MONTHLY RATE CHART FOR RETIREES & SURVIVING …...This Chart applies to all Normal Service...
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9/22/2020 City of Milwaukee Department of Employee Relations 2021 RETIREE RATE CHARTS.xlsx\RC_1 1 General City, Fire or Police Retirees age 65 and over. 2 Ordinary Disability Retiree 3 Certain General City Retirees under age 60, or between 60-65 paying for health coverage. 4 Surviving Spouses of certain General City, Fire or Police Service Retirees. UHC Choice Plus (PPO) UHC Choice (EPO) $934.50 $864.00 $1,869.75 $1,726.50 $2,804.25 $2,590.50 $306.75 $359.25 $579.00 $717.00 $1,329.00 $1,149.75 $1,556.25 $1,544.25 $812.25 $1,113.00 $1,402.50 $1,295.25 $752.25 $753.75 "With Medicare" means having both parts of Medicare, Hospital (Part A) and Medical (Part B). ACA NOTICE : If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. One Adult with Medicare Two Adults with Medicare One Adult with Medicare, One Adult w/o Medicare & Dependent Child(ren) 6 7 One Adult with Medicare, One Adult w/o Medicare 4 5 10 8 Adult with Medicare & Dependent Child(ren) 9 Two Adults with Medicare & Dependent Child(ren) Adult & Dependent Child(ren) no Medicare If you are or your family consists of: Plan Code 1 One Adult No Medicare 3 2 Two Adults no Medicare Two Adults & Dependent Child(ren) no Medicare 2021 MONTHLY RATE CHART FOR RETIREES & SURVIVING SPOUSES These rates are effective January 1, 2021 RATE CHART 1 - These Rates Apply To You If You Are: 2021 Monthly Health Premium Rates - 75% of Full Premium We will deduct the new rates effective with your December 2020 pension check. This is official notification of health plan rates for 2021. DO NOT discard this rate chart.
Transcript of 2021 MONTHLY RATE CHART FOR RETIREES & SURVIVING …...This Chart applies to all Normal Service...
9/22/2020 City of MilwaukeeDepartment of Employee Relations
2021 RETIREE RATE CHARTS.xlsx\RC_1
1 General City, Fire or Police Retirees age 65 and over.2 Ordinary Disability Retiree3 Certain General City Retirees under age 60, or between 60-65 paying for health coverage.4 Surviving Spouses of certain General City, Fire or Police Service Retirees.
UHC Choice Plus(PPO)
UHC Choice(EPO)
$934.50 $864.00
$1,869.75 $1,726.50
$2,804.25 $2,590.50
$306.75 $359.25
$579.00 $717.00
$1,329.00 $1,149.75
$1,556.25 $1,544.25
$812.25 $1,113.00
$1,402.50 $1,295.25
$752.25 $753.75
"With Medicare" means having both parts of Medicare, Hospital (Part A) and Medical (Part B).
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
One Adult with Medicare
Two Adults with Medicare
One Adult with Medicare, One Adult w/o Medicare & Dependent Child(ren)
6
7
One Adult with Medicare, One Adult w/o Medicare
4
5
10
8
Adult with Medicare & Dependent Child(ren)
9
Two Adults with Medicare & Dependent Child(ren)
Adult & Dependent Child(ren) no Medicare
If you are or your family consists of:Plan Code
1 One Adult No Medicare
3
2 Two Adults no Medicare
Two Adults & Dependent Child(ren) no Medicare
2021 MONTHLY RATE CHARTFOR RETIREES & SURVIVING SPOUSES
These rates are effective January 1, 2021
RATE CHART 1 - These Rates Apply To You If You Are:
2021 Monthly Health Premium Rates - 75% of Full Premium
We will deduct the new rates effective with your December 2020 pension check.This is official notification of health plan rates for 2021. DO NOT discard this rate chart.
9/22/2020 City of MilwaukeeDepartment of Employee Relations
2021 RETIREE RATE CHARTS.xlsx\RC_7
We will deduct the new rates effective with your December 2020 pension check.This is official notification of health plan rates for 2021. DO NOT discard this rate chart.
DO NOT discard this rate chart.
RATE CHART 7 - These Monthly Rates Apply To You If You Are:
1 Fire Service Retiree on or after 3/1/85, up to age 65.2 Police Service Retiree on or after 1/1/85, up to age 65.
2021 Monthly Health Premium Rates - 75% of Full Premium
UHC Choice Plus (PPO) UHC Choice (EPO)
City of Milwaukee
Employes' Retirement System (ERS)
789 N. Water St, Suite 300
Milwaukee, WI 53202
"With Medicare" means having both parts of Medicare, Hospital (Part A) and Medical (Part B).
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
10
8
9
Two Adults with Medicare & Dependent Child(ren)
Adult & Dependent Child(ren) no Medicare
Adult with Medicare & Dependent Child(ren)
7
One Adult with Medicare, One Adult w/o Medicare
One Adult with Medicare, One Adult w/o Medicare & Dependent Child(ren)
5 Two Adults with Medicare
Because of the compexity of the rate schedule for your Retiree Group, we are unable to produce a Rate Chart for you that would show all the rates. Each Plan Code shown at left can have 35 different rate permutations.
We could not possibly reproduce all those rates on this one sheet. We therefore ask that if you want to know how much your rate will be for the coming plan year, that you write to ERS at the address shown below.
Please keep in mind that we are especially busy during the Open Enrollment. Even if you call our office for your rate, we may only be able to record your name and address for follow-up in writing.
Two Adults & Dependent Child(ren) no Medicare
1
3
4
6
One Adult No Medicare
Two Adults no Medicare2
One Adult with Medicare
2021 MONTHLY RATE CHARTFOR RETIREES & SURVIVING SPOUSES
These rates are effective January 1, 2021
Plan Code
If you are or your family consists of:
9/22/2020 City of MilwaukeeEmployes' Retirement System
2021 RETIREE RATE CHARTS.xlsx\RC_8_DDGC_Post12-31-90
HEALTH PLAN "EMPLOYEE RATE" INFORMATIONA Duty Disability Retiree will pay the rate listed below under "Employee Rate" for the plan selected each month
CHART 8 - 2021
HEALTH PLAN UHC CHOICE PLAN City Share
Employee Rate
UHC CHOICE PLUS PLAN City Share
Employee Rate
Single 724.00$ 637.12$ 86.88$ 852.00$ 637.12$ 214.88$
Employee + Spouse 1,448.00$ 1,274.24$ 173.76$ 1,705.00$ 1,274.24$ 430.76$
Employee + Child(ren) 1,086.00$ 955.68$ 130.32$ 1,279.00$ 955.68$ 323.32$
Family 2,172.00$ 1,911.36$ 260.64$ 2,557.00$ 1,911.36$ 645.64$
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree may be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
The "Employee Rate" will be deducted from the Retiree's monthly pension.
UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)
2021 MONTHLY RATE CHART FOR DUTY DISABILITY RETIREES
This Chart applies to all Duty Disability Retirees whose positions are represented by any of the following units:
RATE CHART 8
GC Management; District Council #48; NMNR; TEAM; Assc of Scientific Pers; Assc of Muni Attys; SNC; Loc 510 IAM; Loc 494 Mach; Loc 75 Plumbers; Loc 195 Bridge Operators; Loc 139; Loc 61 Sanitation; ALEASP; Police Aides; Loc 494 FEDS; LOC 494, MBCTC; Sworn Fire Mgmt; Milwaukee Professional Firefighters Assc, Loc 215; Milwaukee Police Association (MPA),
Sworn Police Management; Milwaukee Police Supervisors Organization (MPSO)
These rates are effective January 1, 2021
9/22/2020 City of MilwaukeeDepartment of Employee Relations
2021 RETIREE RATE CHARTS.xlsx\RC_16_MGT>0104<0109
COMPUTATION METHOD OF "CITY SHARE"
CHART 16 - 2021
HEALTH PLAN UHC CHOICE PLAN City Share
Retiree Rate
UHC CHOICE PLUS PLAN City Share
Retiree Rate
Single 1,152.00$ 1,152.00$ -$ 1,246.00$ 1,152.00$ 94.00$
Employee + Spouse 2,302.00$ 2,302.00$ -$ 2,493.00$ 2,302.00$ 191.00$
Employee + Child(ren) 1,727.00$ 1,727.00$ -$ 1,870.00$ 1,727.00$ 143.00$
Family 3,454.00$ 3,454.00$ -$ 3,739.00$ 3,454.00$ 285.00$
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree may be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
The "Retiree Rate" will be deducted from the Retiree's monthly pension.
UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)
2021 MONTHLY RATE CHART FOR RETIREES & SURVIVING SPOUSES
RATE CHART 16This Chart applies to all Normal Service Retirees under 65 whose positions are represented by any of the following units and retired on or after
1/1/04 and prior to 1/1/09:
General City Management
The CITY will pay, monthly, 100% of the lowest cost single or lowest cost family plan. This is official notification of health plan rates for 2021. DO NOT discard this rate chart.
These rates are effective January 1, 2021
9/22/2020 City of MilwaukeeDepartment of Employee Relations
2021 RETIREE RATE CHARTS.xlsx\RC_17_GC>010105
*For Loc 494 Elec on or after 1/1/05 and prior to May 31, 2012;*For MBCTC on or after 1/1/05 and prior to July 31, 2012.
CHART 17 - 2021The "Retiree Rate" will be deducted from the Retiree's monthly pension.
HEALTH PLAN UHC CHOICE PLAN City Share
Retiree Rate
UHC CHOICE PLUS PLAN City Share
Retiree Rate
Single 1,152.00$ 1,152.00$ NO COST 1,246.00$ 1,216.00$ 30.00$
Employee + Spouse 2,302.00$ 2,302.00$ NO COST 2,493.00$ 2,433.00$ 60.00$
Employee + Child(ren) 1,727.00$ 1,727.00$ NO COST 1,870.00$ 1,810.00$ 60.00$
Family 3,454.00$ 3,454.00$ NO COST 3,739.00$ 3,679.00$ 60.00$
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree may be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)
2021 MONTHLY RATE CHART FOR GENERAL CITY RETIREES
This Chart applies to all Retirees whose positions are represented by any of the following units:For General City Retirees under 65 retired on or after 1/1/05 and prior to 1/1/12:
RATE CHART 17
District Council 48; Loc 139; Loc 75 Plumbers; Loc 61 Sanitation; SNC; TEAM; Assc of Scient Pers; Assc of Muni Attys; Loc 494 Mach Shop; Loc 510 IAM Dist 10; ALEASP (Clerical & PSS); NMNR; Fire Equip Dispatchers;
These rates are effective January 1, 2021
9/22/2020 City of MilwaukeeDepartment of Employee Relations
2021 RETIREE RATE CHARTS.xlsx\RC_18_GC<0105
A General City Retirees retired prior to 1/1/05A Management retiree retired prior to 1/1/04
A General City or Manangement Duty Disability retiree prior to 1/1/91Sworn Police Management, MPA & MPSO Duty Disability retired prior to 1/1/90
Sworn Fire Management Duty Disability retired prior to 3/1/89Local 215 Duty Disability retired prior to 1/1/90
COMPUTATION METHOD OF "RETIREE SHARE"
CHART 18 - 2021The "Retiree Rate" will be deducted from the Retiree's monthly pension.
HEALTH PLAN UHC CHOICE PLAN City Share
Retiree Rate
UHC CHOICE PLUS PLAN City Share Retiree Rate
Single 1,152.00$ 1,152.00$ NO COST 1,246.00$ 1,246.00$ NO COST
Employee + Spouse 2,302.00$ 2,302.00$ NO COST 2,493.00$ 2,493.00$ NO COST
Employee + Child(ren) 1,727.00$ 1,727.00$ NO COST 1,870.00$ 1,870.00$ NO COST
Family 3,454.00$ 3,454.00$ NO COST 3,739.00$ 3,739.00$ NO COST
2021 MONTHLY RATE CHART FOR GENERAL CITY RETIREESThese rates are effective January 1, 2021
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree may be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
The CITY will pay, monthly, up to 100% of the UHC Choice Plus (PPO) (Basic Plan) single or UHC Choice Plus (PPO) (Basic Plan) family premium cost to the City. For 2021, this contribution ("Retiree Rate") will be no more than $1,176 (Single) or $3,528 (Family) toward the cost of Health Plan of your choice. We will deduct the new rates effective with your December 2019 pension check. This is official notification of health plan rates for 2021. DO NOT discard this rate chart.
This Chart applies to all Retirees under 65 whose positions are represented by any of the following units:
RATE CHART 18
UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)
9/22/2020 City of MilwaukeeEmployes' Retirement System
2021 RETIREE RATE CHARTS.xlsx/RC_20_MGM>0110
The "Retiree Rate" will be deducted from the Retiree's monthly pension.
CHART 20 - 2021
HEALTH PLAN UHC CHOICE PLAN City Share
Retiree Rate
UHC CHOICE PLUS PLAN City Share
Retiree Rate
Single 1,152.00$ 1,013.76$ 138.24$ 1,246.00$ 1,096.48$ 149.52$
Employee + Spouse 2,302.00$ 2,025.76$ 276.24$ 2,493.00$ 2,193.84$ 299.16$
Employee + Child(ren) 1,727.00$ 1,519.76$ 207.24$ 1,870.00$ 1,645.60$ 224.40$
Family 3,454.00$ 3,039.52$ 414.48$ 3,739.00$ 3,290.32$ 448.68$
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree may be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)
2021 MONTHLY RATE CHART FOR RETIREES & SURVIVING SPOUSES
RATE CHART 20
This Chart applies to all Normal Service Retirees under 65 whose positions are represented by any of the following units and retired on or after 1/1/12 through 12/31/2013:
GC Management on or after January 1, 2009 through 12/31/2013;For Loc 494 Elec, on or after May 31, 2012 through 12/31/2013;
For MBCTC, on or after July 31, 2012 through 12/31/2013.
District Council #48; NMNR; TEAM;Assc of Scientific Pers; Assc of Muni Attys; SNC: Loc 510 IAM; Loc 494 Mach; Loc 75 Plumbers;
Loc 195 Bridge Operators; Loc 139; Loc 61 Sanitation; ALEASP; Police Aides; Loc 494 FEDS
These rates are effective January 1, 2021
9/22/2020 City of MilwaukeeEmployes' Retirement System
2021 RETIREE RATE CHARTS.xlsx/RC_21_GC>0114
District Council #48; NMNR; TEAM;Assc of Scientific Pers; Assc of Muni Attys; SNC: Loc 510 IAM; Loc 494 Mach; Loc 75 Plumbers; 195 Bridge Operators;
Loc 139; Loc 61 Sanitation; ALEASP; Police Aides; Loc 494 FEDS; GC Management; Loc 494 Elec; MBCTS
The "Retiree Rate" will be deducted from the Retiree's monthly pension.
CHART 21 - 2021
HEALTH PLAN UHC CHOICE PLAN City Share
Retiree Rate
UHC CHOICE PLUS PLAN City Share
Retiree Rate
Single 1,152.00$ 1,013.76$ 138.24$ 1,246.00$ 1,013.76$ 232.24$
Employee + Spouse 2,302.00$ 2,025.76$ 276.24$ 2,493.00$ 2,025.76$ 467.24$
Employee + Child(ren) 1,727.00$ 1,519.76$ 207.24$ 1,870.00$ 1,519.76$ 350.24$
Family 3,454.00$ 3,039.52$ 414.48$ 3,739.00$ 3,039.52$ 699.48$
ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree may be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits.
2021 MONTHLY RATE CHART FOR RETIREES & SURVIVING SPOUSES
RATE CHART 21This Chart applies to all Normal Service Retirees under 65 whose positions are represented by any of the following units and retired on or after 1/1/14:
UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)
These rates are effective January 1, 2021
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 9 of 50
PC Description UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 1,246.00$ 1,152.00$ 2 Two Adults w/o Medicare 2,493.00$ 2,302.00$ 3 Two Adults & Dependent Child(ren) 3,739.00$ 3,454.00$ 4 One Adult with Medicare 409.00$ 479.00$ 5 Two Adults with Medicare 772.00$ 956.00$ 6 One Adult with Medicare, One person w/o Medicare 1,772.00$ 1,533.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 2,075.00$ 2,059.00$ 8 Two Adults with Medicare & Dependent Child(ren) 1,083.00$ 1,484.00$ 9 Adult & Dependent Child(ren) 1,870.00$ 1,727.00$
10 Adult with Medicare & Dependent Child(ren) 1,003.00$ 1,005.00$ @ 65% City Contribution - POLICE (40hrs/wk) - Unused S/L - Less than 150 work days
PC @65% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 436.10 342.10 2 Two Adults w/o Medicare 872.55 681.55 3 Two Adults & Dependent Child(ren) 1,308.65 1,023.65 4 One Adult with Medicare 143.15 213.15 5 Two Adults with Medicare 270.20 454.20 6 One Adult with Medicare, One person w/o Medicare 620.20 381.20 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 726.25 710.25 8 Two Adults with Medicare & Dependent Child(ren) 379.05 780.05 9 Adult & Dependent Child(ren) 654.50 511.50
10 Adult with Medicare & Dependent Child(ren) 351.05 353.05 @ 66% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 150 but less than 159 work days.
PC @66% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 423.64 329.64 2 Two Adults w/o Medicare 847.62 656.62 3 Two Adults & Dependent Child(ren) 1,271.26 986.26 4 One Adult with Medicare 139.06 209.06 5 Two Adults with Medicare 262.48 446.48 6 One Adult with Medicare, One person w/o Medicare 602.48 363.48 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 705.50 689.50 8 Two Adults with Medicare & Dependent Child(ren) 368.22 769.22 9 Adult & Dependent Child(ren) 635.80 492.80
10 Adult with Medicare & Dependent Child(ren) 341.02 343.02 @ 67% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 159 but less than 167 work days.
PC @67% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 411.18 317.18 2 Two Adults w/o Medicare 822.69 631.69 3 Two Adults & Dependent Child(ren) 1,233.87 948.87 4 One Adult with Medicare 134.97 204.97 5 Two Adults with Medicare 254.76 438.76 6 One Adult with Medicare, One person w/o Medicare 584.76 345.76 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 684.75 668.75 8 Two Adults with Medicare & Dependent Child(ren) 357.39 758.39 9 Adult & Dependent Child(ren) 617.10 474.10
10 Adult with Medicare & Dependent Child(ren) 330.99 332.99
POLICE RATE CHART 7 - FULL 2021 RATE
100% RETIREE PLAN RATES
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 10 of 50
@ 68% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 167 but less than 176 work days.
PC @68% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 398.72 304.72 2 Two Adults w/o Medicare 797.76 606.76 3 Two Adults & Dependent Child(ren) 1,196.48 911.48 4 One Adult with Medicare 130.88 200.88 5 Two Adults with Medicare 247.04 431.04 6 One Adult with Medicare, One person w/o Medicare 567.04 328.04 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 664.00 648.00 8 Two Adults with Medicare & Dependent Child(ren) 346.56 747.56 9 Adult & Dependent Child(ren) 598.40 455.40
10 Adult with Medicare & Dependent Child(ren) 320.96 322.96 @ 69% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 176 but less than 184 work days.
PC @69% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 386.26 292.26 2 Two Adults w/o Medicare 772.83 581.83 3 Two Adults & Dependent Child(ren) 1,159.09 874.09 4 One Adult with Medicare 126.79 196.79 5 Two Adults with Medicare 239.32 423.32 6 One Adult with Medicare, One person w/o Medicare 549.32 310.32 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 643.25 627.25 8 Two Adults with Medicare & Dependent Child(ren) 335.73 736.73 9 Adult & Dependent Child(ren) 579.70 436.70
10 Adult with Medicare & Dependent Child(ren) 310.93 312.93 @ 70% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 184 but less than 193 work days.
PC @70% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 373.80 279.80 2 Two Adults w/o Medicare 747.90 556.90 3 Two Adults & Dependent Child(ren) 1,121.70 836.70 4 One Adult with Medicare 122.70 192.70 5 Two Adults with Medicare 231.60 415.60 6 One Adult with Medicare, One person w/o Medicare 531.60 292.60 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 622.50 606.50 8 Two Adults with Medicare & Dependent Child(ren) 324.90 725.90 9 Adult & Dependent Child(ren) 561.00 418.00
10 Adult with Medicare & Dependent Child(ren) 300.90 302.90 @ 71% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 193 but less than 201 work days.
PC @71% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 361.34 267.34 2 Two Adults w/o Medicare 722.97 531.97 3 Two Adults & Dependent Child(ren) 1,084.31 799.31 4 One Adult with Medicare 118.61 188.61 5 Two Adults with Medicare 223.88 407.88 6 One Adult with Medicare, One person w/o Medicare 513.88 274.88 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 601.75 585.75 8 Two Adults with Medicare & Dependent Child(ren) 314.07 715.07 9 Adult & Dependent Child(ren) 542.30 399.30
10 Adult with Medicare & Dependent Child(ren) 290.87 292.87
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 11 of 50
@ 72% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 201 but less than 210 work days.
PC @72% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 348.88 254.88 2 Two Adults w/o Medicare 698.04 507.04 3 Two Adults & Dependent Child(ren) 1,046.92 761.92 4 One Adult with Medicare 114.52 184.52 5 Two Adults with Medicare 216.16 400.16 6 One Adult with Medicare, One person w/o Medicare 496.16 257.16 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 581.00 565.00 8 Two Adults with Medicare & Dependent Child(ren) 303.24 704.24 9 Adult & Dependent Child(ren) 523.60 380.60
10 Adult with Medicare & Dependent Child(ren) 280.84 282.84 @ 73% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 210 but less than 219 work days.
PC @73% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 336.42 242.42 2 Two Adults w/o Medicare 673.11 482.11 3 Two Adults & Dependent Child(ren) 1,009.53 724.53 4 One Adult with Medicare 110.43 180.43 5 Two Adults with Medicare 208.44 392.44 6 One Adult with Medicare, One person w/o Medicare 478.44 239.44 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 560.25 544.25 8 Two Adults with Medicare & Dependent Child(ren) 292.41 693.41 9 Adult & Dependent Child(ren) 504.90 361.90
10 Adult with Medicare & Dependent Child(ren) 270.81 272.81 @ 74% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 219 but less than 227 work days.
PC @74% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 323.96 229.96 2 Two Adults w/o Medicare 648.18 457.18 3 Two Adults & Dependent Child(ren) 972.14 687.14 4 One Adult with Medicare 106.34 176.34 5 Two Adults with Medicare 200.72 384.72 6 One Adult with Medicare, One person w/o Medicare 460.72 221.72 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 539.50 523.50 8 Two Adults with Medicare & Dependent Child(ren) 281.58 682.58 9 Adult & Dependent Child(ren) 486.20 343.20
10 Adult with Medicare & Dependent Child(ren) 260.78 262.78 @ 75% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 227 but less than 236 work days.
PC @75% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 311.50 217.50 2 Two Adults w/o Medicare 623.25 432.25 3 Two Adults & Dependent Child(ren) 934.75 649.75 4 One Adult with Medicare 102.25 172.25 5 Two Adults with Medicare 193.00 377.00 6 One Adult with Medicare, One person w/o Medicare 443.00 204.00 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 518.75 502.75 8 Two Adults with Medicare & Dependent Child(ren) 270.75 671.75 9 Adult & Dependent Child(ren) 467.50 324.50
10 Adult with Medicare & Dependent Child(ren) 250.75 252.75
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 12 of 50
@ 76% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 236 but less than 244 work days.
PC @76% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 299.04 205.04 2 Two Adults w/o Medicare 598.32 407.32 3 Two Adults & Dependent Child(ren) 897.36 612.36 4 One Adult with Medicare 98.16 168.16 5 Two Adults with Medicare 185.28 369.28 6 One Adult with Medicare, One person w/o Medicare 425.28 186.28 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 498.00 482.00 8 Two Adults with Medicare & Dependent Child(ren) 259.92 660.92 9 Adult & Dependent Child(ren) 448.80 305.80
10 Adult with Medicare & Dependent Child(ren) 240.72 242.72 @ 77% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 244 but less than 253 work days.
PC @77% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 286.58 192.58 2 Two Adults w/o Medicare 573.39 382.39 3 Two Adults & Dependent Child(ren) 859.97 574.97 4 One Adult with Medicare 94.07 164.07 5 Two Adults with Medicare 177.56 361.56 6 One Adult with Medicare, One person w/o Medicare 407.56 168.56 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 477.25 461.25 8 Two Adults with Medicare & Dependent Child(ren) 249.09 650.09 9 Adult & Dependent Child(ren) 430.10 287.10
10 Adult with Medicare & Dependent Child(ren) 230.69 232.69 @ 78% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 253 but less than 261 work days.
PC @78% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 274.12 180.12 2 Two Adults w/o Medicare 548.46 357.46 3 Two Adults & Dependent Child(ren) 822.58 537.58 4 One Adult with Medicare 89.98 159.98 5 Two Adults with Medicare 169.84 353.84 6 One Adult with Medicare, One person w/o Medicare 389.84 150.84 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 456.50 440.50 8 Two Adults with Medicare & Dependent Child(ren) 238.26 639.26 9 Adult & Dependent Child(ren) 411.40 268.40
10 Adult with Medicare & Dependent Child(ren) 220.66 222.66 @ 79% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 261 but less than 270 work days.
PC @79% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 261.66 167.66 2 Two Adults w/o Medicare 523.53 332.53 3 Two Adults & Dependent Child(ren) 785.19 500.19 4 One Adult with Medicare 85.89 155.89 5 Two Adults with Medicare 162.12 346.12 6 One Adult with Medicare, One person w/o Medicare 372.12 133.12 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 435.75 419.75 8 Two Adults with Medicare & Dependent Child(ren) 227.43 628.43 9 Adult & Dependent Child(ren) 392.70 249.70
10 Adult with Medicare & Dependent Child(ren) 210.63 212.63
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 13 of 50
@ 80% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 270 but less than 278 work days.
PC @80% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 249.20 155.20 2 Two Adults w/o Medicare 498.60 307.60 3 Two Adults & Dependent Child(ren) 747.80 462.80 4 One Adult with Medicare 81.80 151.80 5 Two Adults with Medicare 154.40 338.40 6 One Adult with Medicare, One person w/o Medicare 354.40 115.40 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 415.00 399.00 8 Two Adults with Medicare & Dependent Child(ren) 216.60 617.60 9 Adult & Dependent Child(ren) 374.00 231.00
10 Adult with Medicare & Dependent Child(ren) 200.60 202.60 @ 81% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 278 but less than 285 work days.
PC @81% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 236.74 142.74 2 Two Adults w/o Medicare 473.67 282.67 3 Two Adults & Dependent Child(ren) 710.41 425.41 4 One Adult with Medicare 77.71 147.71 5 Two Adults with Medicare 146.68 330.68 6 One Adult with Medicare, One person w/o Medicare 336.68 97.68 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 394.25 378.25 8 Two Adults with Medicare & Dependent Child(ren) 205.77 606.77 9 Adult & Dependent Child(ren) 355.30 212.30
10 Adult with Medicare & Dependent Child(ren) 190.57 192.57 @ 82% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 285 but less than 291 work days.
PC @82% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 224.28 130.28 2 Two Adults w/o Medicare 448.74 257.74 3 Two Adults & Dependent Child(ren) 673.02 388.02 4 One Adult with Medicare 73.62 143.62 5 Two Adults with Medicare 138.96 322.96 6 One Adult with Medicare, One person w/o Medicare 318.96 79.96 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 373.50 357.50 8 Two Adults with Medicare & Dependent Child(ren) 194.94 595.94 9 Adult & Dependent Child(ren) 336.60 193.60
10 Adult with Medicare & Dependent Child(ren) 180.54 182.54 @ 83% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 291 but less than 298 work days.
PC @83% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 211.82 117.82 2 Two Adults w/o Medicare 423.81 232.81 3 Two Adults & Dependent Child(ren) 635.63 350.63 4 One Adult with Medicare 69.53 139.53 5 Two Adults with Medicare 131.24 315.24 6 One Adult with Medicare, One person w/o Medicare 301.24 62.24 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 352.75 336.75 8 Two Adults with Medicare & Dependent Child(ren) 184.11 585.11 9 Adult & Dependent Child(ren) 317.90 174.90
10 Adult with Medicare & Dependent Child(ren) 170.51 172.51
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 14 of 50
@ 84% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 298 but less than 304 work days.
PC @84% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 199.36 105.36 2 Two Adults w/o Medicare 398.88 207.88 3 Two Adults & Dependent Child(ren) 598.24 313.24 4 One Adult with Medicare 65.44 135.44 5 Two Adults with Medicare 123.52 307.52 6 One Adult with Medicare, One person w/o Medicare 283.52 44.52 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 332.00 316.00 8 Two Adults with Medicare & Dependent Child(ren) 173.28 574.28 9 Adult & Dependent Child(ren) 299.20 156.20
10 Adult with Medicare & Dependent Child(ren) 160.48 162.48 @ 85% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 304 but less than 311 work days.
PC @85% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 186.90 92.90 2 Two Adults w/o Medicare 373.95 182.95 3 Two Adults & Dependent Child(ren) 560.85 275.85 4 One Adult with Medicare 61.35 131.35 5 Two Adults with Medicare 115.80 299.80 6 One Adult with Medicare, One person w/o Medicare 265.80 26.80 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 311.25 295.25 8 Two Adults with Medicare & Dependent Child(ren) 162.45 563.45 9 Adult & Dependent Child(ren) 280.50 137.50
10 Adult with Medicare & Dependent Child(ren) 150.45 152.45 @ 86% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 311 but less than 317 work days.
PC @86% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 174.44 80.44 2 Two Adults w/o Medicare 349.02 158.02 3 Two Adults & Dependent Child(ren) 523.46 238.46 4 One Adult with Medicare 57.26 127.26 5 Two Adults with Medicare 108.08 292.08 6 One Adult with Medicare, One person w/o Medicare 248.08 9.08 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 290.50 274.50 8 Two Adults with Medicare & Dependent Child(ren) 151.62 552.62 9 Adult & Dependent Child(ren) 261.80 118.80
10 Adult with Medicare & Dependent Child(ren) 140.42 142.42 @ 87% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 317 but less than 324 work days.
PC @87% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 161.98 67.98 2 Two Adults w/o Medicare 324.09 133.09 3 Two Adults & Dependent Child(ren) 486.07 201.07 4 One Adult with Medicare 53.17 123.17 5 Two Adults with Medicare 100.36 284.36 6 One Adult with Medicare, One person w/o Medicare 230.36 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 269.75 253.75 8 Two Adults with Medicare & Dependent Child(ren) 140.79 541.79 9 Adult & Dependent Child(ren) 243.10 100.10
10 Adult with Medicare & Dependent Child(ren) 130.39 132.39
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 15 of 50
@ 88% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 324 but less than 330 work days.
PC @88% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 149.52 55.52 2 Two Adults w/o Medicare 299.16 108.16 3 Two Adults & Dependent Child(ren) 448.68 163.68 4 One Adult with Medicare 49.08 119.08 5 Two Adults with Medicare 92.64 276.64 6 One Adult with Medicare, One person w/o Medicare 212.64 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 249.00 233.00 8 Two Adults with Medicare & Dependent Child(ren) 129.96 530.96 9 Adult & Dependent Child(ren) 224.40 81.40
10 Adult with Medicare & Dependent Child(ren) 120.36 122.36 @ 89% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 330 but less than 336 work days.
PC @89% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 137.06 43.06 2 Two Adults w/o Medicare 274.23 83.23 3 Two Adults & Dependent Child(ren) 411.29 126.29 4 One Adult with Medicare 44.99 114.99 5 Two Adults with Medicare 84.92 268.92 6 One Adult with Medicare, One person w/o Medicare 194.92 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 228.25 212.25 8 Two Adults with Medicare & Dependent Child(ren) 119.13 520.13 9 Adult & Dependent Child(ren) 205.70 62.70
10 Adult with Medicare & Dependent Child(ren) 110.33 112.33 @ 90% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 336 but less than 343 work days.
PC @90% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 124.60 30.60 2 Two Adults w/o Medicare 249.30 58.30 3 Two Adults & Dependent Child(ren) 373.90 88.90 4 One Adult with Medicare 40.90 110.90 5 Two Adults with Medicare 77.20 261.20 6 One Adult with Medicare, One person w/o Medicare 177.20 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 207.50 191.50 8 Two Adults with Medicare & Dependent Child(ren) 108.30 509.30 9 Adult & Dependent Child(ren) 187.00 44.00
10 Adult with Medicare & Dependent Child(ren) 100.30 102.30 @ 91% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 343 but less than 349 work days.
PC @91% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 112.14 18.14 2 Two Adults w/o Medicare 224.37 33.37 3 Two Adults & Dependent Child(ren) 336.51 51.51 4 One Adult with Medicare 36.81 106.81 5 Two Adults with Medicare 69.48 253.48 6 One Adult with Medicare, One person w/o Medicare 159.48 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 186.75 170.75 8 Two Adults with Medicare & Dependent Child(ren) 97.47 498.47 9 Adult & Dependent Child(ren) 168.30 25.30
10 Adult with Medicare & Dependent Child(ren) 90.27 92.27
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 16 of 50
@ 92% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 349 but less than 356 work days.
PC @92% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 99.68 5.68 2 Two Adults w/o Medicare 199.44 8.44 3 Two Adults & Dependent Child(ren) 299.12 14.12 4 One Adult with Medicare 32.72 102.72 5 Two Adults with Medicare 61.76 245.76 6 One Adult with Medicare, One person w/o Medicare 141.76 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 166.00 150.00 8 Two Adults with Medicare & Dependent Child(ren) 86.64 487.64 9 Adult & Dependent Child(ren) 149.60 6.60
10 Adult with Medicare & Dependent Child(ren) 80.24 82.24 @ 93% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 356 but less than 362 work days.
PC @93% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 87.22 - 2 Two Adults w/o Medicare 174.51 - 3 Two Adults & Dependent Child(ren) 261.73 - 4 One Adult with Medicare 28.63 98.63 5 Two Adults with Medicare 54.04 238.04 6 One Adult with Medicare, One person w/o Medicare 124.04 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 145.25 129.25 8 Two Adults with Medicare & Dependent Child(ren) 75.81 476.81 9 Adult & Dependent Child(ren) 130.90 -
10 Adult with Medicare & Dependent Child(ren) 70.21 72.21 @ 94% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 362 but less than 369 work days.
PC @94% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 74.76 - 2 Two Adults w/o Medicare 149.58 - 3 Two Adults & Dependent Child(ren) 224.34 - 4 One Adult with Medicare 24.54 94.54 5 Two Adults with Medicare 46.32 230.32 6 One Adult with Medicare, One person w/o Medicare 106.32 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 124.50 108.50 8 Two Adults with Medicare & Dependent Child(ren) 64.98 465.98 9 Adult & Dependent Child(ren) 112.20 -
10 Adult with Medicare & Dependent Child(ren) 60.18 62.18 @ 95% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 369 but less than 375 work days.
PC @95% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 62.30 - 2 Two Adults w/o Medicare 124.65 - 3 Two Adults & Dependent Child(ren) 186.95 - 4 One Adult with Medicare 20.45 90.45 5 Two Adults with Medicare 38.60 222.60 6 One Adult with Medicare, One person w/o Medicare 88.60 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 103.75 87.75 8 Two Adults with Medicare & Dependent Child(ren) 54.15 455.15 9 Adult & Dependent Child(ren) 93.50 -
10 Adult with Medicare & Dependent Child(ren) 50.15 52.15
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 17 of 50
@ 96% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 375 but less than 381 work days.
PC @96% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 49.84 - 2 Two Adults w/o Medicare 99.72 - 3 Two Adults & Dependent Child(ren) 149.56 - 4 One Adult with Medicare 16.36 86.36 5 Two Adults with Medicare 30.88 214.88 6 One Adult with Medicare, One person w/o Medicare 70.88 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 83.00 67.00 8 Two Adults with Medicare & Dependent Child(ren) 43.32 444.32 9 Adult & Dependent Child(ren) 74.80 -
10 Adult with Medicare & Dependent Child(ren) 40.12 42.12 @ 97% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 381 but less than 388 work days.
PC @97% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 37.38 - 2 Two Adults w/o Medicare 74.79 - 3 Two Adults & Dependent Child(ren) 112.17 - 4 One Adult with Medicare 12.27 82.27 5 Two Adults with Medicare 23.16 207.16 6 One Adult with Medicare, One person w/o Medicare 53.16 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 62.25 46.25 8 Two Adults with Medicare & Dependent Child(ren) 32.49 433.49 9 Adult & Dependent Child(ren) 56.10 -
10 Adult with Medicare & Dependent Child(ren) 30.09 32.09 @ 98% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 388 but less than 394 work days.
PC @98% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 24.92 - 2 Two Adults w/o Medicare 49.86 - 3 Two Adults & Dependent Child(ren) 74.78 - 4 One Adult with Medicare 8.18 78.18 5 Two Adults with Medicare 15.44 199.44 6 One Adult with Medicare, One person w/o Medicare 35.44 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 41.50 25.50 8 Two Adults with Medicare & Dependent Child(ren) 21.66 422.66 9 Adult & Dependent Child(ren) 37.40 -
10 Adult with Medicare & Dependent Child(ren) 20.06 22.06 @ 99% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 394 but less than 400 work days.
PC @99% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 12.46 - 2 Two Adults w/o Medicare 24.93 - 3 Two Adults & Dependent Child(ren) 37.39 - 4 One Adult with Medicare 4.09 74.09 5 Two Adults with Medicare 7.72 191.72 6 One Adult with Medicare, One person w/o Medicare 17.72 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 20.75 4.75 8 Two Adults with Medicare & Dependent Child(ren) 10.83 411.83 9 Adult & Dependent Child(ren) 18.70 -
10 Adult with Medicare & Dependent Child(ren) 10.03 12.03
9/22/2020 2021 Police until Age 60 (40hrs/wk)
2021 RETIREE RATE CHARTS.xlsx\Police thru age 60 40HRWK 18 of 50
@ 100% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 400 work days.
PC @100% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare - - 2 Two Adults w/o Medicare - - 3 Two Adults & Dependent Child(ren) - - 4 One Adult with Medicare - 70.00 5 Two Adults with Medicare - 184.00 6 One Adult with Medicare, One person w/o Medicare - - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) - - 8 Two Adults with Medicare & Dependent Child(ren) - 401.00 9 Adult & Dependent Child(ren) - -
10 Adult with Medicare & Dependent Child(ren) - 2.00
9/22/2020 2021 HEALTH PLAN RATES FOR POLICE AGE 60-64
19 of 50 2021 RETIREE RATE CHARTS.xlsx\POL 6064
A B C D E F G I J K L M N O
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 65% > of Retiree Retiree Plan 100% 100% 66% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 809.90 1,246.00 0.00 0.00 1 1,246.00 1,246.00 822.36 1,246.00 0.00 0.002 2,493.00 1,246.00 1,620.45 1,620.45 872.55 681.55 2 2,493.00 1,246.00 1,645.38 1,645.38 847.62 656.623 3,739.00 1,246.00 2,430.35 2,430.35 1,308.65 1,023.65 3 3,739.00 1,246.00 2,467.74 2,467.74 1,271.26 986.264 409.00 1,246.00 265.85 1,246.00 0.00 0.00 4 409.00 1,246.00 269.94 1,246.00 0.00 0.005 772.00 1,246.00 501.80 1,246.00 0.00 0.00 5 772.00 1,246.00 509.52 1,246.00 0.00 0.006 1,772.00 1,246.00 1,151.80 1,246.00 526.00 287.00 6 1,772.00 1,246.00 1,169.52 1,246.00 526.00 287.007 2,075.00 1,246.00 1,348.75 1,348.75 726.25 710.25 7 2,075.00 1,246.00 1,369.50 1,369.50 705.50 689.508 1,083.00 1,246.00 703.95 1,246.00 0.00 238.00 8 1,083.00 1,246.00 714.78 1,246.00 0.00 238.009 1,870.00 1,246.00 1,215.50 1,246.00 624.00 481.00 9 1,870.00 1,246.00 1,234.20 1,246.00 624.00 481.0010 1,003.00 1,246.00 651.95 1,246.00 0.00 0.00 10 1,003.00 1,246.00 661.98 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 67% > of Retiree Retiree Plan 100% 100% 68% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 834.82 1,246.00 0.00 0.00 1 1,246.00 1,246.00 847.28 1,246.00 0.00 0.002 2,493.00 1,246.00 1,670.31 1,670.31 822.69 631.69 2 2,493.00 1,246.00 1,695.24 1,695.24 797.76 606.763 3,739.00 1,246.00 2,505.13 2,505.13 1,233.87 948.87 3 3,739.00 1,246.00 2,542.52 2,542.52 1,196.48 911.484 409.00 1,246.00 274.03 1,246.00 0.00 0.00 4 409.00 1,246.00 278.12 1,246.00 0.00 0.005 772.00 1,246.00 517.24 1,246.00 0.00 0.00 5 772.00 1,246.00 524.96 1,246.00 0.00 0.006 1,772.00 1,246.00 1,187.24 1,246.00 526.00 287.00 6 1,772.00 1,246.00 1,204.96 1,246.00 526.00 287.007 2,075.00 1,246.00 1,390.25 1,390.25 684.75 668.75 7 2,075.00 1,246.00 1,411.00 1,411.00 664.00 648.008 1,083.00 1,246.00 725.61 1,246.00 0.00 238.00 8 1,083.00 1,246.00 736.44 1,246.00 0.00 238.009 1,870.00 1,246.00 1,252.90 1,252.90 617.10 474.10 9 1,870.00 1,246.00 1,271.60 1,271.60 598.40 455.4010 1,003.00 1,246.00 672.01 1,246.00 0.00 0.00 10 1,003.00 1,246.00 682.04 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 69% > of Retiree Retiree Plan 100% 100% 70% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 859.74 1,246.00 0.00 0.00 1 1,246.00 1,246.00 872.20 1,246.00 0.00 0.002 2,493.00 1,246.00 1,720.17 1,720.17 772.83 581.83 2 2,493.00 1,246.00 1,745.10 1,745.10 747.90 556.903 3,739.00 1,246.00 2,579.91 2,579.91 1,159.09 874.09 3 3,739.00 1,246.00 2,617.30 2,617.30 1,121.70 836.704 409.00 1,246.00 282.21 1,246.00 0.00 0.00 4 409.00 1,246.00 286.30 1,246.00 0.00 0.005 772.00 1,246.00 532.68 1,246.00 0.00 0.00 5 772.00 1,246.00 540.40 1,246.00 0.00 0.006 1,772.00 1,246.00 1,222.68 1,246.00 526.00 287.00 6 1,772.00 1,246.00 1,240.40 1,246.00 526.00 287.007 2,075.00 1,246.00 1,431.75 1,431.75 643.25 627.25 7 2,075.00 1,246.00 1,452.50 1,452.50 622.50 606.508 1,083.00 1,246.00 747.27 1,246.00 0.00 238.00 8 1,083.00 1,246.00 758.10 1,246.00 0.00 238.009 1,870.00 1,246.00 1,290.30 1,290.30 579.70 436.70 9 1,870.00 1,246.00 1,309.00 1,309.00 561.00 418.0010 1,003.00 1,246.00 692.07 1,246.00 0.00 0.00 10 1,003.00 1,246.00 702.10 1,246.00 0.00 0.00
POLICE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
POLICE FAMILY ENROLLMENT - For a retiree with other than single enrollment status, the City will contribute an amount up the percentage of the subscriber cost for his/her enrollment status in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period after retirement the retiree is less than age 60 and the greater of either such amount or an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
RATE CHART 7 - POLICE 2021 HEALTH PLAN RATES
9/22/2020 2021 HEALTH PLAN RATES FOR POLICE AGE 60-64
20 of 50 2021 RETIREE RATE CHARTS.xlsx\POL 6064
A B C D E F G I J K L M N OUHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 71% > of Retiree Retiree Plan 100% 100% 72% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 884.66 1,246.00 0.00 0.00 1 1,246.00 1,246.00 897.12 1,246.00 0.00 0.002 2,493.00 1,246.00 1,770.03 1,770.03 722.97 531.97 2 2,493.00 1,246.00 1,794.96 1,794.96 698.04 507.043 3,739.00 1,246.00 2,654.69 2,654.69 1,084.31 799.31 3 3,739.00 1,246.00 2,692.08 2,692.08 1,046.92 761.924 409.00 1,246.00 290.39 1,246.00 0.00 0.00 4 409.00 1,246.00 294.48 1,246.00 0.00 0.005 772.00 1,246.00 548.12 1,246.00 0.00 0.00 5 772.00 1,246.00 555.84 1,246.00 0.00 0.006 1,772.00 1,246.00 1,258.12 1,258.12 513.88 274.88 6 1,772.00 1,246.00 1,275.84 1,275.84 496.16 257.167 2,075.00 1,246.00 1,473.25 1,473.25 601.75 585.75 7 2,075.00 1,246.00 1,494.00 1,494.00 581.00 565.008 1,083.00 1,246.00 768.93 1,246.00 0.00 238.00 8 1,083.00 1,246.00 779.76 1,246.00 0.00 238.009 1,870.00 1,246.00 1,327.70 1,327.70 542.30 399.30 9 1,870.00 1,246.00 1,346.40 1,346.40 523.60 380.6010 1,003.00 1,246.00 712.13 1,246.00 0.00 0.00 10 1,003.00 1,246.00 722.16 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 73% > of Retiree Retiree Plan 100% 100% 74% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 909.58 1,246.00 0.00 0.00 1 1,246.00 1,246.00 922.04 1,246.00 0.00 0.002 2,493.00 1,246.00 1,819.89 1,819.89 673.11 482.11 2 2,493.00 1,246.00 1,844.82 1,844.82 648.18 457.183 3,739.00 1,246.00 2,729.47 2,729.47 1,009.53 724.53 3 3,739.00 1,246.00 2,766.86 2,766.86 972.14 687.144 409.00 1,246.00 298.57 1,246.00 0.00 0.00 4 409.00 1,246.00 302.66 1,246.00 0.00 0.005 772.00 1,246.00 563.56 1,246.00 0.00 0.00 5 772.00 1,246.00 571.28 1,246.00 0.00 0.006 1,772.00 1,246.00 1,293.56 1,293.56 478.44 239.44 6 1,772.00 1,246.00 1,311.28 1,311.28 460.72 221.727 2,075.00 1,246.00 1,514.75 1,514.75 560.25 544.25 7 2,075.00 1,246.00 1,535.50 1,535.50 539.50 523.508 1,083.00 1,246.00 790.59 1,246.00 0.00 238.00 8 1,083.00 1,246.00 801.42 1,246.00 0.00 238.009 1,870.00 1,246.00 1,365.10 1,365.10 504.90 361.90 9 1,870.00 1,246.00 1,383.80 1,383.80 486.20 343.2010 1,003.00 1,246.00 732.19 1,246.00 0.00 0.00 10 1,003.00 1,246.00 742.22 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 75% > of Retiree Retiree Plan 100% 100% 76% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 934.50 1,246.00 0.00 0.00 1 1,246.00 1,246.00 946.96 1,246.00 0.00 0.002 2,493.00 1,246.00 1,869.75 1,869.75 623.25 432.25 2 2,493.00 1,246.00 1,894.68 1,894.68 598.32 407.323 3,739.00 1,246.00 2,804.25 2,804.25 934.75 649.75 3 3,739.00 1,246.00 2,841.64 2,841.64 897.36 612.364 409.00 1,246.00 306.75 1,246.00 0.00 0.00 4 409.00 1,246.00 310.84 1,246.00 0.00 0.005 772.00 1,246.00 579.00 1,246.00 0.00 0.00 5 772.00 1,246.00 586.72 1,246.00 0.00 0.006 1,772.00 1,246.00 1,329.00 1,329.00 443.00 204.00 6 1,772.00 1,246.00 1,346.72 1,346.72 425.28 186.287 2,075.00 1,246.00 1,556.25 1,556.25 518.75 502.75 7 2,075.00 1,246.00 1,577.00 1,577.00 498.00 482.008 1,083.00 1,246.00 812.25 1,246.00 0.00 238.00 8 1,083.00 1,246.00 823.08 1,246.00 0.00 238.009 1,870.00 1,246.00 1,402.50 1,402.50 467.50 324.50 9 1,870.00 1,246.00 1,421.20 1,421.20 448.80 305.8010 1,003.00 1,246.00 752.25 1,246.00 0.00 0.00 10 1,003.00 1,246.00 762.28 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 77% > of Retiree Retiree Plan 100% 100% 78% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 959.42 1,246.00 0.00 0.00 1 1,246.00 1,246.00 971.88 1,246.00 0.00 0.002 2,493.00 1,246.00 1,919.61 1,919.61 573.39 382.39 2 2,493.00 1,246.00 1,944.54 1,944.54 548.46 357.463 3,739.00 1,246.00 2,879.03 2,879.03 859.97 574.97 3 3,739.00 1,246.00 2,916.42 2,916.42 822.58 537.584 409.00 1,246.00 314.93 1,246.00 0.00 0.00 4 409.00 1,246.00 319.02 1,246.00 0.00 0.005 772.00 1,246.00 594.44 1,246.00 0.00 0.00 5 772.00 1,246.00 602.16 1,246.00 0.00 0.006 1,772.00 1,246.00 1,364.44 1,364.44 407.56 168.56 6 1,772.00 1,246.00 1,382.16 1,382.16 389.84 150.847 2,075.00 1,246.00 1,597.75 1,597.75 477.25 461.25 7 2,075.00 1,246.00 1,618.50 1,618.50 456.50 440.508 1,083.00 1,246.00 833.91 1,246.00 0.00 238.00 8 1,083.00 1,246.00 844.74 1,246.00 0.00 238.009 1,870.00 1,246.00 1,439.90 1,439.90 430.10 287.10 9 1,870.00 1,246.00 1,458.60 1,458.60 411.40 268.4010 1,003.00 1,246.00 772.31 1,246.00 0.00 0.00 10 1,003.00 1,246.00 782.34 1,246.00 0.00 0.00
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A B C D E F G I J K L M N OUHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 79% > of Retiree Retiree Plan 100% 100% 80% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 984.34 1,246.00 0.00 0.00 1 1,246.00 1,246.00 996.80 1,246.00 0.00 0.002 2,493.00 1,246.00 1,969.47 1,969.47 523.53 332.53 2 2,493.00 1,246.00 1,994.40 1,994.40 498.60 307.603 3,739.00 1,246.00 2,953.81 2,953.81 785.19 500.19 3 3,739.00 1,246.00 2,991.20 2,991.20 747.80 462.804 409.00 1,246.00 323.11 1,246.00 0.00 0.00 4 409.00 1,246.00 327.20 1,246.00 0.00 0.005 772.00 1,246.00 609.88 1,246.00 0.00 0.00 5 772.00 1,246.00 617.60 1,246.00 0.00 0.006 1,772.00 1,246.00 1,399.88 1,399.88 372.12 133.12 6 1,772.00 1,246.00 1,417.60 1,417.60 354.40 115.407 2,075.00 1,246.00 1,639.25 1,639.25 435.75 419.75 7 2,075.00 1,246.00 1,660.00 1,660.00 415.00 399.008 1,083.00 1,246.00 855.57 1,246.00 0.00 238.00 8 1,083.00 1,246.00 866.40 1,246.00 0.00 238.009 1,870.00 1,246.00 1,477.30 1,477.30 392.70 249.70 9 1,870.00 1,246.00 1,496.00 1,496.00 374.00 231.0010 1,003.00 1,246.00 792.37 1,246.00 0.00 0.00 10 1,003.00 1,246.00 802.40 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 81% > of Retiree Retiree Plan 100% 100% 82% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,009.26 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,021.72 1,246.00 0.00 0.002 2,493.00 1,246.00 2,019.33 2,019.33 473.67 282.67 2 2,493.00 1,246.00 2,044.26 2,044.26 448.74 257.743 3,739.00 1,246.00 3,028.59 3,028.59 710.41 425.41 3 3,739.00 1,246.00 3,065.98 3,065.98 673.02 388.024 409.00 1,246.00 331.29 1,246.00 0.00 0.00 4 409.00 1,246.00 335.38 1,246.00 0.00 0.005 772.00 1,246.00 625.32 1,246.00 0.00 0.00 5 772.00 1,246.00 633.04 1,246.00 0.00 0.006 1,772.00 1,246.00 1,435.32 1,435.32 336.68 97.68 6 1,772.00 1,246.00 1,453.04 1,453.04 318.96 79.967 2,075.00 1,246.00 1,680.75 1,680.75 394.25 378.25 7 2,075.00 1,246.00 1,701.50 1,701.50 373.50 357.508 1,083.00 1,246.00 877.23 1,246.00 0.00 238.00 8 1,083.00 1,246.00 888.06 1,246.00 0.00 238.009 1,870.00 1,246.00 1,514.70 1,514.70 355.30 212.30 9 1,870.00 1,246.00 1,533.40 1,533.40 336.60 193.6010 1,003.00 1,246.00 812.43 1,246.00 0.00 0.00 10 1,003.00 1,246.00 822.46 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 83% > of Retiree Retiree Plan 100% 100% 84% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,034.18 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,046.64 1,246.00 0.00 0.002 2,493.00 1,246.00 2,069.19 2,069.19 423.81 232.81 2 2,493.00 1,246.00 2,094.12 2,094.12 398.88 207.883 3,739.00 1,246.00 3,103.37 3,103.37 635.63 350.63 3 3,739.00 1,246.00 3,140.76 3,140.76 598.24 313.244 409.00 1,246.00 339.47 1,246.00 0.00 0.00 4 409.00 1,246.00 343.56 1,246.00 0.00 0.005 772.00 1,246.00 640.76 1,246.00 0.00 0.00 5 772.00 1,246.00 648.48 1,246.00 0.00 0.006 1,772.00 1,246.00 1,470.76 1,470.76 301.24 62.24 6 1,772.00 1,246.00 1,488.48 1,488.48 283.52 44.527 2,075.00 1,246.00 1,722.25 1,722.25 352.75 336.75 7 2,075.00 1,246.00 1,743.00 1,743.00 332.00 316.008 1,083.00 1,246.00 898.89 1,246.00 0.00 238.00 8 1,083.00 1,246.00 909.72 1,246.00 0.00 238.009 1,870.00 1,246.00 1,552.10 1,552.10 317.90 174.90 9 1,870.00 1,246.00 1,570.80 1,570.80 299.20 156.2010 1,003.00 1,246.00 832.49 1,246.00 0.00 0.00 10 1,003.00 1,246.00 842.52 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 85% > of Retiree Retiree Plan 100% 100% 86% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,059.10 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,071.56 1,246.00 0.00 0.002 2,493.00 1,246.00 2,119.05 2,119.05 373.95 182.95 2 2,493.00 1,246.00 2,143.98 2,143.98 349.02 158.023 3,739.00 1,246.00 3,178.15 3,178.15 560.85 275.85 3 3,739.00 1,246.00 3,215.54 3,215.54 523.46 238.464 409.00 1,246.00 347.65 1,246.00 0.00 0.00 4 409.00 1,246.00 351.74 1,246.00 0.00 0.005 772.00 1,246.00 656.20 1,246.00 0.00 0.00 5 772.00 1,246.00 663.92 1,246.00 0.00 0.006 1,772.00 1,246.00 1,506.20 1,506.20 265.80 26.80 6 1,772.00 1,246.00 1,523.92 1,523.92 248.08 9.087 2,075.00 1,246.00 1,763.75 1,763.75 311.25 295.25 7 2,075.00 1,246.00 1,784.50 1,784.50 290.50 274.508 1,083.00 1,246.00 920.55 1,246.00 0.00 238.00 8 1,083.00 1,246.00 931.38 1,246.00 0.00 238.009 1,870.00 1,246.00 1,589.50 1,589.50 280.50 137.50 9 1,870.00 1,246.00 1,608.20 1,608.20 261.80 118.8010 1,003.00 1,246.00 852.55 1,246.00 0.00 0.00 10 1,003.00 1,246.00 862.58 1,246.00 0.00 0.00
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A B C D E F G I J K L M N OUHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 87% > of Retiree Retiree Plan 100% 100% 88% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,084.02 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,096.48 1,246.00 0.00 0.002 2,493.00 1,246.00 2,168.91 2,168.91 324.09 133.09 2 2,493.00 1,246.00 2,193.84 2,193.84 299.16 108.163 3,739.00 1,246.00 3,252.93 3,252.93 486.07 201.07 3 3,739.00 1,246.00 3,290.32 3,290.32 448.68 163.684 409.00 1,246.00 355.83 1,246.00 0.00 0.00 4 409.00 1,246.00 359.92 1,246.00 0.00 0.005 772.00 1,246.00 671.64 1,246.00 0.00 0.00 5 772.00 1,246.00 679.36 1,246.00 0.00 0.006 1,772.00 1,246.00 1,541.64 1,541.64 230.36 0.00 6 1,772.00 1,246.00 1,559.36 1,559.36 212.64 0.007 2,075.00 1,246.00 1,805.25 1,805.25 269.75 253.75 7 2,075.00 1,246.00 1,826.00 1,826.00 249.00 233.008 1,083.00 1,246.00 942.21 1,246.00 0.00 238.00 8 1,083.00 1,246.00 953.04 1,246.00 0.00 238.009 1,870.00 1,246.00 1,626.90 1,626.90 243.10 100.10 9 1,870.00 1,246.00 1,645.60 1,645.60 224.40 81.4010 1,003.00 1,246.00 872.61 1,246.00 0.00 0.00 10 1,003.00 1,246.00 882.64 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 89% > of Retiree Retiree Plan 100% 100% 90% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,108.94 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,121.40 1,246.00 0.00 0.002 2,493.00 1,246.00 2,218.77 2,218.77 274.23 83.23 2 2,493.00 1,246.00 2,243.70 2,243.70 249.30 58.303 3,739.00 1,246.00 3,327.71 3,327.71 411.29 126.29 3 3,739.00 1,246.00 3,365.10 3,365.10 373.90 88.904 409.00 1,246.00 364.01 1,246.00 0.00 0.00 4 409.00 1,246.00 368.10 1,246.00 0.00 0.005 772.00 1,246.00 687.08 1,246.00 0.00 0.00 5 772.00 1,246.00 694.80 1,246.00 0.00 0.006 1,772.00 1,246.00 1,577.08 1,577.08 194.92 0.00 6 1,772.00 1,246.00 1,594.80 1,594.80 177.20 0.007 2,075.00 1,246.00 1,846.75 1,846.75 228.25 212.25 7 2,075.00 1,246.00 1,867.50 1,867.50 207.50 191.508 1,083.00 1,246.00 963.87 1,246.00 0.00 238.00 8 1,083.00 1,246.00 974.70 1,246.00 0.00 238.009 1,870.00 1,246.00 1,664.30 1,664.30 205.70 62.70 9 1,870.00 1,246.00 1,683.00 1,683.00 187.00 44.0010 1,003.00 1,246.00 892.67 1,246.00 0.00 0.00 10 1,003.00 1,246.00 902.70 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 91% > of Retiree Retiree Plan 100% 100% 92% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,133.86 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,146.32 1,246.00 0.00 0.002 2,493.00 1,246.00 2,268.63 2,268.63 224.37 33.37 2 2,493.00 1,246.00 2,293.56 2,293.56 199.44 8.443 3,739.00 1,246.00 3,402.49 3,402.49 336.51 51.51 3 3,739.00 1,246.00 3,439.88 3,439.88 299.12 14.124 409.00 1,246.00 372.19 1,246.00 0.00 0.00 4 409.00 1,246.00 376.28 1,246.00 0.00 0.005 772.00 1,246.00 702.52 1,246.00 0.00 0.00 5 772.00 1,246.00 710.24 1,246.00 0.00 0.006 1,772.00 1,246.00 1,612.52 1,612.52 159.48 0.00 6 1,772.00 1,246.00 1,630.24 1,630.24 141.76 0.007 2,075.00 1,246.00 1,888.25 1,888.25 186.75 170.75 7 2,075.00 1,246.00 1,909.00 1,909.00 166.00 150.008 1,083.00 1,246.00 985.53 1,246.00 0.00 238.00 8 1,083.00 1,246.00 996.36 1,246.00 0.00 238.009 1,870.00 1,246.00 1,701.70 1,701.70 168.30 25.30 9 1,870.00 1,246.00 1,720.40 1,720.40 149.60 6.6010 1,003.00 1,246.00 912.73 1,246.00 0.00 0.00 10 1,003.00 1,246.00 922.76 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 93% > of Retiree Retiree Plan 100% 100% 94% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,158.78 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,171.24 1,246.00 0.00 0.002 2,493.00 1,246.00 2,318.49 2,318.49 174.51 0.00 2 2,493.00 1,246.00 2,343.42 2,343.42 149.58 0.003 3,739.00 1,246.00 3,477.27 3,477.27 261.73 0.00 3 3,739.00 1,246.00 3,514.66 3,514.66 224.34 0.004 409.00 1,246.00 380.37 1,246.00 0.00 0.00 4 409.00 1,246.00 384.46 1,246.00 0.00 0.005 772.00 1,246.00 717.96 1,246.00 0.00 0.00 5 772.00 1,246.00 725.68 1,246.00 0.00 0.006 1,772.00 1,246.00 1,647.96 1,647.96 124.04 0.00 6 1,772.00 1,246.00 1,665.68 1,665.68 106.32 0.007 2,075.00 1,246.00 1,929.75 1,929.75 145.25 129.25 7 2,075.00 1,246.00 1,950.50 1,950.50 124.50 108.508 1,083.00 1,246.00 1,007.19 1,246.00 0.00 238.00 8 1,083.00 1,246.00 1,018.02 1,246.00 0.00 238.009 1,870.00 1,246.00 1,739.10 1,739.10 130.90 0.00 9 1,870.00 1,246.00 1,757.80 1,757.80 112.20 0.0010 1,003.00 1,246.00 932.79 1,246.00 0.00 0.00 10 1,003.00 1,246.00 942.82 1,246.00 0.00 0.00
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A B C D E F G I J K L M N OUHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 95% > of Retiree Retiree Plan 100% 100% 96% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,183.70 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,196.16 1,246.00 0.00 0.002 2,493.00 1,246.00 2,368.35 2,368.35 124.65 0.00 2 2,493.00 1,246.00 2,393.28 2,393.28 99.72 0.003 3,739.00 1,246.00 3,552.05 3,552.05 186.95 0.00 3 3,739.00 1,246.00 3,589.44 3,589.44 149.56 0.004 409.00 1,246.00 388.55 1,246.00 0.00 0.00 4 409.00 1,246.00 392.64 1,246.00 0.00 0.005 772.00 1,246.00 733.40 1,246.00 0.00 0.00 5 772.00 1,246.00 741.12 1,246.00 0.00 0.006 1,772.00 1,246.00 1,683.40 1,683.40 88.60 0.00 6 1,772.00 1,246.00 1,701.12 1,701.12 70.88 0.007 2,075.00 1,246.00 1,971.25 1,971.25 103.75 87.75 7 2,075.00 1,246.00 1,992.00 1,992.00 83.00 67.008 1,083.00 1,246.00 1,028.85 1,246.00 0.00 238.00 8 1,083.00 1,246.00 1,039.68 1,246.00 0.00 238.009 1,870.00 1,246.00 1,776.50 1,776.50 93.50 0.00 9 1,870.00 1,246.00 1,795.20 1,795.20 74.80 0.0010 1,003.00 1,246.00 952.85 1,246.00 0.00 0.00 10 1,003.00 1,246.00 962.88 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 97% > of Retiree Retiree Plan 100% 100% 98% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,208.62 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,221.08 1,246.00 0.00 0.002 2,493.00 1,246.00 2,418.21 2,418.21 74.79 0.00 2 2,493.00 1,246.00 2,443.14 2,443.14 49.86 0.003 3,739.00 1,246.00 3,626.83 3,626.83 112.17 0.00 3 3,739.00 1,246.00 3,664.22 3,664.22 74.78 0.004 409.00 1,246.00 396.73 1,246.00 0.00 0.00 4 409.00 1,246.00 400.82 1,246.00 0.00 0.005 772.00 1,246.00 748.84 1,246.00 0.00 0.00 5 772.00 1,246.00 756.56 1,246.00 0.00 0.006 1,772.00 1,246.00 1,718.84 1,718.84 53.16 0.00 6 1,772.00 1,246.00 1,736.56 1,736.56 35.44 0.007 2,075.00 1,246.00 2,012.75 2,012.75 62.25 46.25 7 2,075.00 1,246.00 2,033.50 2,033.50 41.50 25.508 1,083.00 1,246.00 1,050.51 1,246.00 0.00 238.00 8 1,083.00 1,246.00 1,061.34 1,246.00 0.00 238.009 1,870.00 1,246.00 1,813.90 1,813.90 56.10 0.00 9 1,870.00 1,246.00 1,832.60 1,832.60 37.40 0.0010 1,003.00 1,246.00 972.91 1,246.00 0.00 0.00 10 1,003.00 1,246.00 982.94 1,246.00 0.00 0.00
UHC CHOICE PLUS (PPO)
UHC CHOICE (EPO)
UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)
Plan 100% 100% 99% > of Retiree Retiree Plan 100% 100% 100% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays
1 1,246.00 1,246.00 1,233.54 1,246.00 0.00 0.00 1 1,246.00 1,246.00 1,246.00 1,246.00 0.00 0.002 2,493.00 1,246.00 2,468.07 2,468.07 24.93 0.00 2 2,493.00 1,246.00 2,493.00 2,493.00 0.00 0.003 3,739.00 1,246.00 3,701.61 3,701.61 37.39 0.00 3 3,739.00 1,246.00 3,739.00 3,739.00 0.00 0.004 409.00 1,246.00 404.91 1,246.00 0.00 0.00 4 409.00 1,246.00 409.00 1,246.00 0.00 0.005 772.00 1,246.00 764.28 1,246.00 0.00 0.00 5 772.00 1,246.00 772.00 1,246.00 0.00 0.006 1,772.00 1,246.00 1,754.28 1,754.28 17.72 0.00 6 1,772.00 1,246.00 1,772.00 1,772.00 0.00 0.007 2,075.00 1,246.00 2,054.25 2,054.25 20.75 4.75 7 2,075.00 1,246.00 2,075.00 2,075.00 0.00 0.008 1,083.00 1,246.00 1,072.17 1,246.00 0.00 238.00 8 1,083.00 1,246.00 1,083.00 1,246.00 0.00 238.009 1,870.00 1,246.00 1,851.30 1,851.30 18.70 0.00 9 1,870.00 1,246.00 1,870.00 1,870.00 0.00 0.0010 1,003.00 1,246.00 992.97 1,246.00 0.00 0.00 10 1,003.00 1,246.00 1,003.00 1,246.00 0.00 0.00
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 24 of 50Department of Employee Relations
City Hall, Room 706
PC Description UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 1,246.00$ 1,152.00$ 2 Two Adults w/o Medicare 2,493.00$ 2,302.00$ 3 Two Adults & Dependent Child(ren) 3,739.00$ 3,454.00$ 4 One Adult with Medicare 409.00$ 479.00$ 5 Two Adults with Medicare 772.00$ 956.00$ 6 One Adult with Medicare, One person w/o Medicare 1,772.00$ 1,533.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 2,075.00$ 2,059.00$ 8 Two Adults with Medicare & Dependent Child(ren) 1,083.00$ 1,484.00$ 9 Adult & Dependent Child(ren) 1,870.00$ 1,727.00$
10 Adult with Medicare & Dependent Child(ren) 1,003.00$ 1,005.00$
RATE CHART 7 - FULL 2021 RATEFIRE - EXCEED 40 HRS PER WEEK
100% RETIREE PLAN RATES
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 25 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 65% City Contribution Unused S/L - Less than 70 work days
PC Description @65% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 436.10$ 342.10$ 2 Two Adults w/o Medicare 872.55$ 681.55$ 3 Two Adults & Dependent Child(ren) 1,308.65$ 1,023.65$ 4 One Adult with Medicare 143.15$ 213.15$ 5 Two Adults with Medicare 270.20$ 454.20$ 6 One Adult with Medicare, One person w/o Medicare 620.20$ 381.20$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 726.25$ 710.25$ 8 Two Adults with Medicare & Dependent Child(ren) 379.05$ 780.05$ 9 Adult & Dependent Child(ren) 654.50$ 511.50$
10 Adult with Medicare & Dependent Child(ren) 351.05$ 353.05$ FIRE (Exceed 40hrs/wk)
@ 66% City Contribution Unused S/L - At least 70 but less than 74 work
days
PC Description @66% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 423.64$ 329.64$ 2 Two Adults w/o Medicare 847.62$ 656.62$ 3 Two Adults & Dependent Child(ren) 1,271.26$ 986.26$ 4 One Adult with Medicare 139.06$ 209.06$ 5 Two Adults with Medicare 262.48$ 446.48$ 6 One Adult with Medicare, One person w/o Medicare 602.48$ 363.48$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 705.50$ 689.50$ 8 Two Adults with Medicare & Dependent Child(ren) 368.22$ 769.22$ 9 Adult & Dependent Child(ren) 635.80$ 492.80$
10 Adult with Medicare & Dependent Child(ren) 341.02$ 343.02$ FIRE (Exceed 40hrs/wk)
@ 67% City Contribution Unused S/L - At least 74 but less than 78 work
days
PC Description @67% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 411.18$ 317.18$ 2 Two Adults w/o Medicare 822.69$ 631.69$ 3 Two Adults & Dependent Child(ren) 1,233.87$ 948.87$ 4 One Adult with Medicare 134.97$ 204.97$ 5 Two Adults with Medicare 254.76$ 438.76$ 6 One Adult with Medicare, One person w/o Medicare 584.76$ 345.76$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 684.75$ 668.75$ 8 Two Adults with Medicare & Dependent Child(ren) 357.39$ 758.39$ 9 Adult & Dependent Child(ren) 617.10$ 474.10$
10 Adult with Medicare & Dependent Child(ren) 330.99$ 332.99$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 26 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 68% City Contribution Unused S/L - At least 78 but less than 82 work
days
PC Description @68% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 398.72$ 304.72$ 2 Two Adults w/o Medicare 797.76$ 606.76$ 3 Two Adults & Dependent Child(ren) 1,196.48$ 911.48$ 4 One Adult with Medicare 130.88$ 200.88$ 5 Two Adults with Medicare 247.04$ 431.04$ 6 One Adult with Medicare, One person w/o Medicare 567.04$ 328.04$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 664.00$ 648.00$ 8 Two Adults with Medicare & Dependent Child(ren) 346.56$ 747.56$ 9 Adult & Dependent Child(ren) 598.40$ 455.40$
10 Adult with Medicare & Dependent Child(ren) 320.96$ 322.96$ FIRE (Exceed 40hrs/wk)
@ 69% City Contribution Unused S/L - At least 82 but less than 86 work
days
PC Description @69% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 386.26$ 292.26$ 2 Two Adults w/o Medicare 772.83$ 581.83$ 3 Two Adults & Dependent Child(ren) 1,159.09$ 874.09$ 4 One Adult with Medicare 126.79$ 196.79$ 5 Two Adults with Medicare 239.32$ 423.32$ 6 One Adult with Medicare, One person w/o Medicare 549.32$ 310.32$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 643.25$ 627.25$ 8 Two Adults with Medicare & Dependent Child(ren) 335.73$ 736.73$ 9 Adult & Dependent Child(ren) 579.70$ 436.70$
10 Adult with Medicare & Dependent Child(ren) 310.93$ 312.93$ FIRE (Exceed 40hrs/wk)
@ 70% City Contribution Unused S/L - At least 86 but less than 90 work
days
PC Description @70% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 373.80$ 279.80$ 2 Two Adults w/o Medicare 747.90$ 556.90$ 3 Two Adults & Dependent Child(ren) 1,121.70$ 836.70$ 4 One Adult with Medicare 122.70$ 192.70$ 5 Two Adults with Medicare 231.60$ 415.60$ 6 One Adult with Medicare, One person w/o Medicare 531.60$ 292.60$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 622.50$ 606.50$ 8 Two Adults with Medicare & Dependent Child(ren) 324.90$ 725.90$ 9 Adult & Dependent Child(ren) 561.00$ 418.00$
10 Adult with Medicare & Dependent Child(ren) 300.90$ 302.90$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 27 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 71% City Contribution Unused S/L - At least 90 but less than 94 work
days
PC Description @71% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 361.34$ 267.34$ 2 Two Adults w/o Medicare 722.97$ 531.97$ 3 Two Adults & Dependent Child(ren) 1,084.31$ 799.31$ 4 One Adult with Medicare 118.61$ 188.61$ 5 Two Adults with Medicare 223.88$ 407.88$ 6 One Adult with Medicare, One person w/o Medicare 513.88$ 274.88$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 601.75$ 585.75$ 8 Two Adults with Medicare & Dependent Child(ren) 314.07$ 715.07$ 9 Adult & Dependent Child(ren) 542.30$ 399.30$
10 Adult with Medicare & Dependent Child(ren) 290.87$ 292.87$ FIRE (Exceed 40hrs/wk)
@ 72% City Contribution Unused S/L - At least 94 but less than 98 work
days
PC Description @72% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 348.88$ 254.88$ 2 Two Adults w/o Medicare 698.04$ 507.04$ 3 Two Adults & Dependent Child(ren) 1,046.92$ 761.92$ 4 One Adult with Medicare 114.52$ 184.52$ 5 Two Adults with Medicare 216.16$ 400.16$ 6 One Adult with Medicare, One person w/o Medicare 496.16$ 257.16$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 581.00$ 565.00$ 8 Two Adults with Medicare & Dependent Child(ren) 303.24$ 704.24$ 9 Adult & Dependent Child(ren) 523.60$ 380.60$
10 Adult with Medicare & Dependent Child(ren) 280.84$ 282.84$ FIRE (Exceed 40hrs/wk)
@ 73% City Contribution Unused S/L - At least 98 but less than 102 work
days
PC Description @73% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 336.42$ 242.42$ 2 Two Adults w/o Medicare 673.11$ 482.11$ 3 Two Adults & Dependent Child(ren) 1,009.53$ 724.53$ 4 One Adult with Medicare 110.43$ 180.43$ 5 Two Adults with Medicare 208.44$ 392.44$ 6 One Adult with Medicare, One person w/o Medicare 478.44$ 239.44$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 560.25$ 544.25$ 8 Two Adults with Medicare & Dependent Child(ren) 292.41$ 693.41$ 9 Adult & Dependent Child(ren) 504.90$ 361.90$
10 Adult with Medicare & Dependent Child(ren) 270.81$ 272.81$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 28 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 74% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
102 but less than 106 work days
PC Description @74% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 323.96$ 229.96$ 2 Two Adults w/o Medicare 648.18$ 457.18$ 3 Two Adults & Dependent Child(ren) 972.14$ 687.14$ 4 One Adult with Medicare 106.34$ 176.34$ 5 Two Adults with Medicare 200.72$ 384.72$ 6 One Adult with Medicare, One person w/o Medicare 460.72$ 221.72$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 539.50$ 523.50$ 8 Two Adults with Medicare & Dependent Child(ren) 281.58$ 682.58$ 9 Adult & Dependent Child(ren) 486.20$ 343.20$
10 Adult with Medicare & Dependent Child(ren) 260.78$ 262.78$ FIRE (Exceed 40hrs/wk)
@ 75% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
106 but less than 110 work days
PC Description @75% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 311.50$ 217.50$ 2 Two Adults w/o Medicare 623.25$ 432.25$ 3 Two Adults & Dependent Child(ren) 934.75$ 649.75$ 4 One Adult with Medicare 102.25$ 172.25$ 5 Two Adults with Medicare 193.00$ 377.00$ 6 One Adult with Medicare, One person w/o Medicare 443.00$ 204.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 518.75$ 502.75$ 8 Two Adults with Medicare & Dependent Child(ren) 270.75$ 671.75$ 9 Adult & Dependent Child(ren) 467.50$ 324.50$
10 Adult with Medicare & Dependent Child(ren) 250.75$ 252.75$ FIRE (Exceed 40hrs/wk)
@ 76% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
110 but less than 114 work days
PC Description @76% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 299.04$ 205.04$ 2 Two Adults w/o Medicare 598.32$ 407.32$ 3 Two Adults & Dependent Child(ren) 897.36$ 612.36$ 4 One Adult with Medicare 98.16$ 168.16$ 5 Two Adults with Medicare 185.28$ 369.28$ 6 One Adult with Medicare, One person w/o Medicare 425.28$ 186.28$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 498.00$ 482.00$ 8 Two Adults with Medicare & Dependent Child(ren) 259.92$ 660.92$ 9 Adult & Dependent Child(ren) 448.80$ 305.80$
10 Adult with Medicare & Dependent Child(ren) 240.72$ 242.72$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 29 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 77% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
114 but less than 118 work days
PC Description @77% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 286.58$ 192.58$ 2 Two Adults w/o Medicare 573.39$ 382.39$ 3 Two Adults & Dependent Child(ren) 859.97$ 574.97$ 4 One Adult with Medicare 94.07$ 164.07$ 5 Two Adults with Medicare 177.56$ 361.56$ 6 One Adult with Medicare, One person w/o Medicare 407.56$ 168.56$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 477.25$ 461.25$ 8 Two Adults with Medicare & Dependent Child(ren) 249.09$ 650.09$ 9 Adult & Dependent Child(ren) 430.10$ 287.10$
10 Adult with Medicare & Dependent Child(ren) 230.69$ 232.69$ FIRE (Exceed 40hrs/wk)
@ 78% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
118 but less than 122 work days
PC Description @78% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 274.12$ 180.12$ 2 Two Adults w/o Medicare 548.46$ 357.46$ 3 Two Adults & Dependent Child(ren) 822.58$ 537.58$ 4 One Adult with Medicare 89.98$ 159.98$ 5 Two Adults with Medicare 169.84$ 353.84$ 6 One Adult with Medicare, One person w/o Medicare 389.84$ 150.84$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 456.50$ 440.50$ 8 Two Adults with Medicare & Dependent Child(ren) 238.26$ 639.26$ 9 Adult & Dependent Child(ren) 411.40$ 268.40$
10 Adult with Medicare & Dependent Child(ren) 220.66$ 222.66$ FIRE (Exceed 40hrs/wk)
@ 79% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
122 but less than 126 work days
PC Description @79% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 261.66$ 167.66$ 2 Two Adults w/o Medicare 523.53$ 332.53$ 3 Two Adults & Dependent Child(ren) 785.19$ 500.19$ 4 One Adult with Medicare 85.89$ 155.89$ 5 Two Adults with Medicare 162.12$ 346.12$ 6 One Adult with Medicare, One person w/o Medicare 372.12$ 133.12$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 435.75$ 419.75$ 8 Two Adults with Medicare & Dependent Child(ren) 227.43$ 628.43$ 9 Adult & Dependent Child(ren) 392.70$ 249.70$
10 Adult with Medicare & Dependent Child(ren) 210.63$ 212.63$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 30 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 80% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
126 but less than 130 work days
PC Description @80% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 249.20$ 155.20$ 2 Two Adults w/o Medicare 498.60$ 307.60$ 3 Two Adults & Dependent Child(ren) 747.80$ 462.80$ 4 One Adult with Medicare 81.80$ 151.80$ 5 Two Adults with Medicare 154.40$ 338.40$ 6 One Adult with Medicare, One person w/o Medicare 354.40$ 115.40$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 415.00$ 399.00$ 8 Two Adults with Medicare & Dependent Child(ren) 216.60$ 617.60$ 9 Adult & Dependent Child(ren) 374.00$ 231.00$
10 Adult with Medicare & Dependent Child(ren) 200.60$ 202.60$ FIRE (Exceed 40hrs/wk)
@ 81% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
130 but less than 133 work days
PC Description @81% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 236.74$ 142.74$ 2 Two Adults w/o Medicare 473.67$ 282.67$ 3 Two Adults & Dependent Child(ren) 710.41$ 425.41$ 4 One Adult with Medicare 77.71$ 147.71$ 5 Two Adults with Medicare 146.68$ 330.68$ 6 One Adult with Medicare, One person w/o Medicare 336.68$ 97.68$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 394.25$ 378.25$ 8 Two Adults with Medicare & Dependent Child(ren) 205.77$ 606.77$ 9 Adult & Dependent Child(ren) 355.30$ 212.30$
10 Adult with Medicare & Dependent Child(ren) 190.57$ 192.57$ FIRE (Exceed 40hrs/wk)
@ 82% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
133 but less than 136 work days
PC Description @82% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 224.28$ 130.28$ 2 Two Adults w/o Medicare 448.74$ 257.74$ 3 Two Adults & Dependent Child(ren) 673.02$ 388.02$ 4 One Adult with Medicare 73.62$ 143.62$ 5 Two Adults with Medicare 138.96$ 322.96$ 6 One Adult with Medicare, One person w/o Medicare 318.96$ 79.96$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 373.50$ 357.50$ 8 Two Adults with Medicare & Dependent Child(ren) 194.94$ 595.94$ 9 Adult & Dependent Child(ren) 336.60$ 193.60$
10 Adult with Medicare & Dependent Child(ren) 180.54$ 182.54$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 31 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 83% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
136 but less than 139 work days
PC Description @83% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 211.82$ 117.82$ 2 Two Adults w/o Medicare 423.81$ 232.81$ 3 Two Adults & Dependent Child(ren) 635.63$ 350.63$ 4 One Adult with Medicare 69.53$ 139.53$ 5 Two Adults with Medicare 131.24$ 315.24$ 6 One Adult with Medicare, One person w/o Medicare 301.24$ 62.24$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 352.75$ 336.75$ 8 Two Adults with Medicare & Dependent Child(ren) 184.11$ 585.11$ 9 Adult & Dependent Child(ren) 317.90$ 174.90$
10 Adult with Medicare & Dependent Child(ren) 170.51$ 172.51$ FIRE (Exceed 40hrs/wk)
@ 84% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
139 but less than 142 work days
PC Description @84% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 199.36$ 105.36$ 2 Two Adults w/o Medicare 398.88$ 207.88$ 3 Two Adults & Dependent Child(ren) 598.24$ 313.24$ 4 One Adult with Medicare 65.44$ 135.44$ 5 Two Adults with Medicare 123.52$ 307.52$ 6 One Adult with Medicare, One person w/o Medicare 283.52$ 44.52$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 332.00$ 316.00$ 8 Two Adults with Medicare & Dependent Child(ren) 173.28$ 574.28$ 9 Adult & Dependent Child(ren) 299.20$ 156.20$
10 Adult with Medicare & Dependent Child(ren) 160.48$ 162.48$ FIRE (Exceed 40hrs/wk)
@ 85% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
142 but less than 145 work days
PC Description @85% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 186.90$ 92.90$ 2 Two Adults w/o Medicare 373.95$ 182.95$ 3 Two Adults & Dependent Child(ren) 560.85$ 275.85$ 4 One Adult with Medicare 61.35$ 131.35$ 5 Two Adults with Medicare 115.80$ 299.80$ 6 One Adult with Medicare, One person w/o Medicare 265.80$ 26.80$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 311.25$ 295.25$ 8 Two Adults with Medicare & Dependent Child(ren) 162.45$ 563.45$ 9 Adult & Dependent Child(ren) 280.50$ 137.50$
10 Adult with Medicare & Dependent Child(ren) 150.45$ 152.45$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 32 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 86% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
145 but less than 148 work days
PC Description @86% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 174.44$ 80.44$ 2 Two Adults w/o Medicare 349.02$ 158.02$ 3 Two Adults & Dependent Child(ren) 523.46$ 238.46$ 4 One Adult with Medicare 57.26$ 127.26$ 5 Two Adults with Medicare 108.08$ 292.08$ 6 One Adult with Medicare, One person w/o Medicare 248.08$ 9.08$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 290.50$ 274.50$ 8 Two Adults with Medicare & Dependent Child(ren) 151.62$ 552.62$ 9 Adult & Dependent Child(ren) 261.80$ 118.80$
10 Adult with Medicare & Dependent Child(ren) 140.42$ 142.42$ FIRE (Exceed 40hrs/wk)
@ 87% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
148 but less than 151 work days
PC Description @87% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 161.98$ 67.98$ 2 Two Adults w/o Medicare 324.09$ 133.09$ 3 Two Adults & Dependent Child(ren) 486.07$ 201.07$ 4 One Adult with Medicare 53.17$ 123.17$ 5 Two Adults with Medicare 100.36$ 284.36$ 6 One Adult with Medicare, One person w/o Medicare 230.36$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 269.75$ 253.75$ 8 Two Adults with Medicare & Dependent Child(ren) 140.79$ 541.79$ 9 Adult & Dependent Child(ren) 243.10$ 100.10$
10 Adult with Medicare & Dependent Child(ren) 130.39$ 132.39$ FIRE (Exceed 40hrs/wk)
@ 88% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
151 but less than 154 work days
PC Description @88% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 149.52$ 55.52$ 2 Two Adults w/o Medicare 299.16$ 108.16$ 3 Two Adults & Dependent Child(ren) 448.68$ 163.68$ 4 One Adult with Medicare 49.08$ 119.08$ 5 Two Adults with Medicare 92.64$ 276.64$ 6 One Adult with Medicare, One person w/o Medicare 212.64$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 249.00$ 233.00$ 8 Two Adults with Medicare & Dependent Child(ren) 129.96$ 530.96$ 9 Adult & Dependent Child(ren) 224.40$ 81.40$
10 Adult with Medicare & Dependent Child(ren) 120.36$ 122.36$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 33 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 89% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
154 but less than 157 work days
PC Description @89% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 137.06$ 43.06$ 2 Two Adults w/o Medicare 274.23$ 83.23$ 3 Two Adults & Dependent Child(ren) 411.29$ 126.29$ 4 One Adult with Medicare 44.99$ 114.99$ 5 Two Adults with Medicare 84.92$ 268.92$ 6 One Adult with Medicare, One person w/o Medicare 194.92$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 228.25$ 212.25$ 8 Two Adults with Medicare & Dependent Child(ren) 119.13$ 520.13$ 9 Adult & Dependent Child(ren) 205.70$ 62.70$
10 Adult with Medicare & Dependent Child(ren) 110.33$ 112.33$ FIRE (Exceed 40hrs/wk)
@ 90% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
157 but less than 160 work days
PC Description @90% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 124.60$ 30.60$ 2 Two Adults w/o Medicare 249.30$ 58.30$ 3 Two Adults & Dependent Child(ren) 373.90$ 88.90$ 4 One Adult with Medicare 40.90$ 110.90$ 5 Two Adults with Medicare 77.20$ 261.20$ 6 One Adult with Medicare, One person w/o Medicare 177.20$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 207.50$ 191.50$ 8 Two Adults with Medicare & Dependent Child(ren) 108.30$ 509.30$ 9 Adult & Dependent Child(ren) 187.00$ 44.00$
10 Adult with Medicare & Dependent Child(ren) 100.30$ 102.30$ FIRE (Exceed 40hrs/wk)
@ 91% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
160 but less than 163 work days
PC Description @91% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 112.14$ 18.14$ 2 Two Adults w/o Medicare 224.37$ 33.37$ 3 Two Adults & Dependent Child(ren) 336.51$ 51.51$ 4 One Adult with Medicare 36.81$ 106.81$ 5 Two Adults with Medicare 69.48$ 253.48$ 6 One Adult with Medicare, One person w/o Medicare 159.48$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 186.75$ 170.75$ 8 Two Adults with Medicare & Dependent Child(ren) 97.47$ 498.47$ 9 Adult & Dependent Child(ren) 168.30$ 25.30$
10 Adult with Medicare & Dependent Child(ren) 90.27$ 92.27$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 34 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 92% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
163 but less than 166 work days
PC Description @92% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 99.68$ 5.68$ 2 Two Adults w/o Medicare 199.44$ 8.44$ 3 Two Adults & Dependent Child(ren) 299.12$ 14.12$ 4 One Adult with Medicare 32.72$ 102.72$ 5 Two Adults with Medicare 61.76$ 245.76$ 6 One Adult with Medicare, One person w/o Medicare 141.76$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 166.00$ 150.00$ 8 Two Adults with Medicare & Dependent Child(ren) 86.64$ 487.64$ 9 Adult & Dependent Child(ren) 149.60$ 6.60$
10 Adult with Medicare & Dependent Child(ren) 80.24$ 82.24$ FIRE (Exceed 40hrs/wk)
@ 93% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
166 but less than 169 work days
PC Description @93% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 87.22$ -$ 2 Two Adults w/o Medicare 174.51$ -$ 3 Two Adults & Dependent Child(ren) 261.73$ -$ 4 One Adult with Medicare 28.63$ 98.63$ 5 Two Adults with Medicare 54.04$ 238.04$ 6 One Adult with Medicare, One person w/o Medicare 124.04$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 145.25$ 129.25$ 8 Two Adults with Medicare & Dependent Child(ren) 75.81$ 476.81$ 9 Adult & Dependent Child(ren) 130.90$ -$
10 Adult with Medicare & Dependent Child(ren) 70.21$ 72.21$ FIRE (Exceed 40hrs/wk)
@ 94% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
169 but less than 172 work days
PC Description @94% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 74.76$ -$ 2 Two Adults w/o Medicare 149.58$ -$ 3 Two Adults & Dependent Child(ren) 224.34$ -$ 4 One Adult with Medicare 24.54$ 94.54$ 5 Two Adults with Medicare 46.32$ 230.32$ 6 One Adult with Medicare, One person w/o Medicare 106.32$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 124.50$ 108.50$ 8 Two Adults with Medicare & Dependent Child(ren) 64.98$ 465.98$ 9 Adult & Dependent Child(ren) 112.20$ -$
10 Adult with Medicare & Dependent Child(ren) 60.18$ 62.18$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 35 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 95% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
172 but less than 175 work days
PC Description @95% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 62.30$ -$ 2 Two Adults w/o Medicare 124.65$ -$ 3 Two Adults & Dependent Child(ren) 186.95$ -$ 4 One Adult with Medicare 20.45$ 90.45$ 5 Two Adults with Medicare 38.60$ 222.60$ 6 One Adult with Medicare, One person w/o Medicare 88.60$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 103.75$ 87.75$ 8 Two Adults with Medicare & Dependent Child(ren) 54.15$ 455.15$ 9 Adult & Dependent Child(ren) 93.50$ -$
10 Adult with Medicare & Dependent Child(ren) 50.15$ 52.15$ FIRE (Exceed 40hrs/wk)
@ 96% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
175 but less than 178 work days
PC Description @96% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 49.84$ -$ 2 Two Adults w/o Medicare 99.72$ -$ 3 Two Adults & Dependent Child(ren) 149.56$ -$ 4 One Adult with Medicare 16.36$ 86.36$ 5 Two Adults with Medicare 30.88$ 214.88$ 6 One Adult with Medicare, One person w/o Medicare 70.88$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 83.00$ 67.00$ 8 Two Adults with Medicare & Dependent Child(ren) 43.32$ 444.32$ 9 Adult & Dependent Child(ren) 74.80$ -$
10 Adult with Medicare & Dependent Child(ren) 40.12$ 42.12$ FIRE (Exceed 40hrs/wk)
@ 97% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
178 but less than 181 work days
PC Description @97% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 37.38$ -$ 2 Two Adults w/o Medicare 74.79$ -$ 3 Two Adults & Dependent Child(ren) 112.17$ -$ 4 One Adult with Medicare 12.27$ 82.27$ 5 Two Adults with Medicare 23.16$ 207.16$ 6 One Adult with Medicare, One person w/o Medicare 53.16$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 62.25$ 46.25$ 8 Two Adults with Medicare & Dependent Child(ren) 32.49$ 433.49$ 9 Adult & Dependent Child(ren) 56.10$ -$
10 Adult with Medicare & Dependent Child(ren) 30.09$ 32.09$
9/22/2020 2021 FIRE CONTRIBUTION RATE UNTIL AGE 60 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 36 of 50Department of Employee Relations
City Hall, Room 706
FIRE (Exceed 40hrs/wk)
@ 98% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
181 but less than 184 work days
PC Description @98% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 24.92$ -$ 2 Two Adults w/o Medicare 49.86$ -$ 3 Two Adults & Dependent Child(ren) 74.78$ -$ 4 One Adult with Medicare 8.18$ 78.18$ 5 Two Adults with Medicare 15.44$ 199.44$ 6 One Adult with Medicare, One person w/o Medicare 35.44$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 41.50$ 25.50$ 8 Two Adults with Medicare & Dependent Child(ren) 21.66$ 422.66$ 9 Adult & Dependent Child(ren) 37.40$ -$
10 Adult with Medicare & Dependent Child(ren) 20.06$ 22.06$ FIRE (Exceed 40hrs/wk)
@ 99% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
184 but less than 187 work days
PC Description @99% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare 12.46$ -$ 2 Two Adults w/o Medicare 24.93$ -$ 3 Two Adults & Dependent Child(ren) 37.39$ -$ 4 One Adult with Medicare 4.09$ 74.09$ 5 Two Adults with Medicare 7.72$ 191.72$ 6 One Adult with Medicare, One person w/o Medicare 17.72$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 20.75$ 4.75$ 8 Two Adults with Medicare & Dependent Child(ren) 10.83$ 411.83$ 9 Adult & Dependent Child(ren) 18.70$ -$
10 Adult with Medicare & Dependent Child(ren) 10.03$ 12.03$ FIRE (Exceed 40hrs/wk)
@ 100% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
187 work days
PC Description @100% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare -$ -$ 3 Two Adults & Dependent Child(ren) -$ -$ 4 One Adult with Medicare -$ 70.00$ 5 Two Adults with Medicare -$ 184.00$ 6 One Adult with Medicare, One person w/o Medicare -$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) -$ -$ 8 Two Adults with Medicare & Dependent Child(ren) -$ 401.00$ 9 Adult & Dependent Child(ren) -$ -$
10 Adult with Medicare & Dependent Child(ren) -$ 2.00$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 37 of 50Department of Employee Relations
City Hall, Room 706
PC Description UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 2,493.00$ 2,302.00$ 3 Two Adults & Dependent Child(ren) 3,739.00$ 3,454.00$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 772.00$ 956.00$ 6 One Adult with Medicare, One person w/o Medicare 1,772.00$ 1,533.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 2,075.00$ 2,059.00$ 8 Two Adults with Medicare & Dependent Child(ren) 1,083.00$ 1,484.00$ 9 Adult & Dependent Child(ren) 1,870.00$ 1,727.00$
10 Adult with Medicare & Dependent Child(ren) 1,003.00$ 1,005.00$
RATE CHART 7 - FULL 2021 RATEFIRE - EXCEED 40 HRS PER WEEK - Ages 60 - 64
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
100% RETIREE PLAN RATES
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 38 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 65% City Contribution Unused S/L - Less than 70 work days
PC Description @65% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 872.55$ 681.55$ 3 Two Adults & Dependent Child(ren) 1,308.65$ 1,023.65$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 270.20$ 454.20$ 6 One Adult with Medicare, One person w/o Medicare 620.20$ 381.20$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 726.25$ 710.25$ 8 Two Adults with Medicare & Dependent Child(ren) 379.05$ 780.05$ 9 Adult & Dependent Child(ren) 654.50$ 511.50$
10 Adult with Medicare & Dependent Child(ren) 351.05$ 353.05$ FIRE (Exceed 40hrs/wk)
@ 66% City Contribution Unused S/L - At least 70 but less than 74 work
days
PC Description @66% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 847.62$ 656.62$ 3 Two Adults & Dependent Child(ren) 1,271.26$ 986.26$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 262.48$ 446.48$ 6 One Adult with Medicare, One person w/o Medicare 602.48$ 363.48$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 705.50$ 689.50$ 8 Two Adults with Medicare & Dependent Child(ren) 368.22$ 769.22$ 9 Adult & Dependent Child(ren) 635.80$ 492.80$
10 Adult with Medicare & Dependent Child(ren) 341.02$ 343.02$ FIRE (Exceed 40hrs/wk)
@ 67% City Contribution Unused S/L - At least 74 but less than 78 work
days
PC Description @67% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 822.69$ 631.69$ 3 Two Adults & Dependent Child(ren) 1,233.87$ 948.87$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 254.76$ 438.76$ 6 One Adult with Medicare, One person w/o Medicare 584.76$ 345.76$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 684.75$ 668.75$ 8 Two Adults with Medicare & Dependent Child(ren) 357.39$ 758.39$ 9 Adult & Dependent Child(ren) 617.10$ 474.10$
10 Adult with Medicare & Dependent Child(ren) 330.99$ 332.99$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 39 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 68% City Contribution Unused S/L - At least 78 but less than 82 work
days
PC Description @68% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 797.76$ 606.76$ 3 Two Adults & Dependent Child(ren) 1,196.48$ 911.48$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 247.04$ 431.04$ 6 One Adult with Medicare, One person w/o Medicare 567.04$ 328.04$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 664.00$ 648.00$ 8 Two Adults with Medicare & Dependent Child(ren) 346.56$ 747.56$ 9 Adult & Dependent Child(ren) 598.40$ 455.40$
10 Adult with Medicare & Dependent Child(ren) 320.96$ 322.96$ FIRE (Exceed 40hrs/wk)
@ 69% City Contribution Unused S/L - At least 82 but less than 86 work
days
PC Description @69% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 772.83$ 581.83$ 3 Two Adults & Dependent Child(ren) 1,159.09$ 874.09$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 239.32$ 423.32$ 6 One Adult with Medicare, One person w/o Medicare 549.32$ 310.32$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 643.25$ 627.25$ 8 Two Adults with Medicare & Dependent Child(ren) 335.73$ 736.73$ 9 Adult & Dependent Child(ren) 579.70$ 436.70$
10 Adult with Medicare & Dependent Child(ren) 310.93$ 312.93$ FIRE (Exceed 40hrs/wk)
@ 70% City Contribution Unused S/L - At least 86 but less than 90 work
days
PC Description @70% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 747.90$ 556.90$ 3 Two Adults & Dependent Child(ren) 1,121.70$ 836.70$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 231.60$ 415.60$ 6 One Adult with Medicare, One person w/o Medicare 531.60$ 292.60$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 622.50$ 606.50$ 8 Two Adults with Medicare & Dependent Child(ren) 324.90$ 725.90$ 9 Adult & Dependent Child(ren) 561.00$ 418.00$
10 Adult with Medicare & Dependent Child(ren) 300.90$ 302.90$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 40 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 71% City Contribution Unused S/L - At least 90 but less than 94 work
days
PC Description @71% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 722.97$ 531.97$ 3 Two Adults & Dependent Child(ren) 1,084.31$ 799.31$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 223.88$ 407.88$ 6 One Adult with Medicare, One person w/o Medicare 513.88$ 274.88$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 601.75$ 585.75$ 8 Two Adults with Medicare & Dependent Child(ren) 314.07$ 715.07$ 9 Adult & Dependent Child(ren) 542.30$ 399.30$
10 Adult with Medicare & Dependent Child(ren) 290.87$ 292.87$ FIRE (Exceed 40hrs/wk)
@ 72% City Contribution Unused S/L - At least 94 but less than 98 work
days
PC Description @72% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 698.04$ 507.04$ 3 Two Adults & Dependent Child(ren) 1,046.92$ 761.92$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 216.16$ 400.16$ 6 One Adult with Medicare, One person w/o Medicare 496.16$ 257.16$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 581.00$ 565.00$ 8 Two Adults with Medicare & Dependent Child(ren) 303.24$ 704.24$ 9 Adult & Dependent Child(ren) 523.60$ 380.60$
10 Adult with Medicare & Dependent Child(ren) 280.84$ 282.84$ FIRE (Exceed 40hrs/wk)
@ 73% City Contribution Unused S/L - At least 98 but less than 102 work
days
PC Description @73% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 673.11$ 482.11$ 3 Two Adults & Dependent Child(ren) 1,009.53$ 724.53$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 208.44$ 392.44$ 6 One Adult with Medicare, One person w/o Medicare 478.44$ 239.44$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 560.25$ 544.25$ 8 Two Adults with Medicare & Dependent Child(ren) 292.41$ 693.41$ 9 Adult & Dependent Child(ren) 504.90$ 361.90$
10 Adult with Medicare & Dependent Child(ren) 270.81$ 272.81$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 41 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 74% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
102 but less than 106 work days
PC Description @74% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 648.18$ 457.18$ 3 Two Adults & Dependent Child(ren) 972.14$ 687.14$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 200.72$ 384.72$ 6 One Adult with Medicare, One person w/o Medicare 460.72$ 221.72$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 539.50$ 523.50$ 8 Two Adults with Medicare & Dependent Child(ren) 281.58$ 682.58$ 9 Adult & Dependent Child(ren) 486.20$ 343.20$
10 Adult with Medicare & Dependent Child(ren) 260.78$ 262.78$ FIRE (Exceed 40hrs/wk)
@ 75% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
106 but less than 110 work days
PC Description @75% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 623.25$ 432.25$ 3 Two Adults & Dependent Child(ren) 934.75$ 649.75$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 193.00$ 377.00$ 6 One Adult with Medicare, One person w/o Medicare 443.00$ 204.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 518.75$ 502.75$ 8 Two Adults with Medicare & Dependent Child(ren) 270.75$ 671.75$ 9 Adult & Dependent Child(ren) 467.50$ 324.50$
10 Adult with Medicare & Dependent Child(ren) 250.75$ 252.75$ FIRE (Exceed 40hrs/wk)
@ 76% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
110 but less than 114 work days
PC Description @76% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 598.32$ 407.32$ 3 Two Adults & Dependent Child(ren) 897.36$ 612.36$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 185.28$ 369.28$ 6 One Adult with Medicare, One person w/o Medicare 425.28$ 186.28$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 498.00$ 482.00$ 8 Two Adults with Medicare & Dependent Child(ren) 259.92$ 660.92$ 9 Adult & Dependent Child(ren) 448.80$ 305.80$
10 Adult with Medicare & Dependent Child(ren) 240.72$ 242.72$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 42 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 77% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
114 but less than 118 work days
PC Description @77% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 573.39$ 382.39$ 3 Two Adults & Dependent Child(ren) 859.97$ 574.97$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 177.56$ 361.56$ 6 One Adult with Medicare, One person w/o Medicare 407.56$ 168.56$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 477.25$ 461.25$ 8 Two Adults with Medicare & Dependent Child(ren) 249.09$ 650.09$ 9 Adult & Dependent Child(ren) 430.10$ 287.10$
10 Adult with Medicare & Dependent Child(ren) 230.69$ 232.69$ FIRE (Exceed 40hrs/wk)
@ 78% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
118 but less than 122 work days
PC Description @78% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 548.46$ 357.46$ 3 Two Adults & Dependent Child(ren) 822.58$ 537.58$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 169.84$ 353.84$ 6 One Adult with Medicare, One person w/o Medicare 389.84$ 150.84$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 456.50$ 440.50$ 8 Two Adults with Medicare & Dependent Child(ren) 238.26$ 639.26$ 9 Adult & Dependent Child(ren) 411.40$ 268.40$
10 Adult with Medicare & Dependent Child(ren) 220.66$ 222.66$ FIRE (Exceed 40hrs/wk)
@ 79% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
122 but less than 126 work days
PC Description @79% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 523.53$ 332.53$ 3 Two Adults & Dependent Child(ren) 785.19$ 500.19$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 162.12$ 346.12$ 6 One Adult with Medicare, One person w/o Medicare 372.12$ 133.12$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 435.75$ 419.75$ 8 Two Adults with Medicare & Dependent Child(ren) 227.43$ 628.43$ 9 Adult & Dependent Child(ren) 392.70$ 249.70$
10 Adult with Medicare & Dependent Child(ren) 210.63$ 212.63$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 43 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 80% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
126 but less than 130 work days
PC Description @80% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 498.60$ 307.60$ 3 Two Adults & Dependent Child(ren) 747.80$ 462.80$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 154.40$ 338.40$ 6 One Adult with Medicare, One person w/o Medicare 354.40$ 115.40$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 415.00$ 399.00$ 8 Two Adults with Medicare & Dependent Child(ren) 216.60$ 617.60$ 9 Adult & Dependent Child(ren) 374.00$ 231.00$
10 Adult with Medicare & Dependent Child(ren) 200.60$ 202.60$ FIRE (Exceed 40hrs/wk)
@ 81% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
130 but less than 133 work days
PC Description @81% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 473.67$ 282.67$ 3 Two Adults & Dependent Child(ren) 710.41$ 425.41$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 146.68$ 330.68$ 6 One Adult with Medicare, One person w/o Medicare 336.68$ 97.68$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 394.25$ 378.25$ 8 Two Adults with Medicare & Dependent Child(ren) 205.77$ 606.77$ 9 Adult & Dependent Child(ren) 355.30$ 212.30$
10 Adult with Medicare & Dependent Child(ren) 190.57$ 192.57$ FIRE (Exceed 40hrs/wk)
@ 82% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
133 but less than 136 work days
PC Description @82% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 448.74$ 257.74$ 3 Two Adults & Dependent Child(ren) 673.02$ 388.02$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 138.96$ 322.96$ 6 One Adult with Medicare, One person w/o Medicare 318.96$ 79.96$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 373.50$ 357.50$ 8 Two Adults with Medicare & Dependent Child(ren) 194.94$ 595.94$ 9 Adult & Dependent Child(ren) 336.60$ 193.60$
10 Adult with Medicare & Dependent Child(ren) 180.54$ 182.54$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 44 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 83% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
136 but less than 139 work days
PC Description @83% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 423.81$ 232.81$ 3 Two Adults & Dependent Child(ren) 635.63$ 350.63$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 131.24$ 315.24$ 6 One Adult with Medicare, One person w/o Medicare 301.24$ 62.24$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 352.75$ 336.75$ 8 Two Adults with Medicare & Dependent Child(ren) 184.11$ 585.11$ 9 Adult & Dependent Child(ren) 317.90$ 174.90$
10 Adult with Medicare & Dependent Child(ren) 170.51$ 172.51$ FIRE (Exceed 40hrs/wk)
@ 84% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
139 but less than 142 work days
PC Description @84% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 398.88$ 207.88$ 3 Two Adults & Dependent Child(ren) 598.24$ 313.24$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 123.52$ 307.52$ 6 One Adult with Medicare, One person w/o Medicare 283.52$ 44.52$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 332.00$ 316.00$ 8 Two Adults with Medicare & Dependent Child(ren) 173.28$ 574.28$ 9 Adult & Dependent Child(ren) 299.20$ 156.20$
10 Adult with Medicare & Dependent Child(ren) 160.48$ 162.48$ FIRE (Exceed 40hrs/wk)
@ 85% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
142 but less than 145 work days
PC Description @85% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 373.95$ 182.95$ 3 Two Adults & Dependent Child(ren) 560.85$ 275.85$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 115.80$ 299.80$ 6 One Adult with Medicare, One person w/o Medicare 265.80$ 26.80$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 311.25$ 295.25$ 8 Two Adults with Medicare & Dependent Child(ren) 162.45$ 563.45$ 9 Adult & Dependent Child(ren) 280.50$ 137.50$
10 Adult with Medicare & Dependent Child(ren) 150.45$ 152.45$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 45 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 86% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
145 but less than 148 work days
PC Description @86% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 349.02$ 158.02$ 3 Two Adults & Dependent Child(ren) 523.46$ 238.46$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 108.08$ 292.08$ 6 One Adult with Medicare, One person w/o Medicare 248.08$ 9.08$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 290.50$ 274.50$ 8 Two Adults with Medicare & Dependent Child(ren) 151.62$ 552.62$ 9 Adult & Dependent Child(ren) 261.80$ 118.80$
10 Adult with Medicare & Dependent Child(ren) 140.42$ 142.42$ FIRE (Exceed 40hrs/wk)
@ 87% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
148 but less than 151 work days
PC Description @87% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 324.09$ 133.09$ 3 Two Adults & Dependent Child(ren) 486.07$ 201.07$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 100.36$ 284.36$ 6 One Adult with Medicare, One person w/o Medicare 230.36$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 269.75$ 253.75$ 8 Two Adults with Medicare & Dependent Child(ren) 140.79$ 541.79$ 9 Adult & Dependent Child(ren) 243.10$ 100.10$
10 Adult with Medicare & Dependent Child(ren) 130.39$ 132.39$ FIRE (Exceed 40hrs/wk)
@ 88% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
151 but less than 154 work days
PC Description @88% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 299.16$ 108.16$ 3 Two Adults & Dependent Child(ren) 448.68$ 163.68$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 92.64$ 276.64$ 6 One Adult with Medicare, One person w/o Medicare 212.64$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 249.00$ 233.00$ 8 Two Adults with Medicare & Dependent Child(ren) 129.96$ 530.96$ 9 Adult & Dependent Child(ren) 224.40$ 81.40$
10 Adult with Medicare & Dependent Child(ren) 120.36$ 122.36$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 46 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 89% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
154 but less than 157 work days
PC Description @89% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 274.23$ 83.23$ 3 Two Adults & Dependent Child(ren) 411.29$ 126.29$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 84.92$ 268.92$ 6 One Adult with Medicare, One person w/o Medicare 194.92$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 228.25$ 212.25$ 8 Two Adults with Medicare & Dependent Child(ren) 119.13$ 520.13$ 9 Adult & Dependent Child(ren) 205.70$ 62.70$
10 Adult with Medicare & Dependent Child(ren) 110.33$ 112.33$ FIRE (Exceed 40hrs/wk)
@ 90% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
157 but less than 160 work days
PC Description @90% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 249.30$ 58.30$ 3 Two Adults & Dependent Child(ren) 373.90$ 88.90$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 77.20$ 261.20$ 6 One Adult with Medicare, One person w/o Medicare 177.20$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 207.50$ 191.50$ 8 Two Adults with Medicare & Dependent Child(ren) 108.30$ 509.30$ 9 Adult & Dependent Child(ren) 187.00$ 44.00$
10 Adult with Medicare & Dependent Child(ren) 100.30$ 102.30$ FIRE (Exceed 40hrs/wk)
@ 91% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
160 but less than 163 work days
PC Description @91% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 224.37$ 33.37$ 3 Two Adults & Dependent Child(ren) 336.51$ 51.51$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 69.48$ 253.48$ 6 One Adult with Medicare, One person w/o Medicare 159.48$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 186.75$ 170.75$ 8 Two Adults with Medicare & Dependent Child(ren) 97.47$ 498.47$ 9 Adult & Dependent Child(ren) 168.30$ 25.30$
10 Adult with Medicare & Dependent Child(ren) 90.27$ 92.27$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 47 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 92% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
163 but less than 166 work days
PC Description @92% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 199.44$ 8.44$ 3 Two Adults & Dependent Child(ren) 299.12$ 14.12$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 61.76$ 245.76$ 6 One Adult with Medicare, One person w/o Medicare 141.76$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 166.00$ 150.00$ 8 Two Adults with Medicare & Dependent Child(ren) 86.64$ 487.64$ 9 Adult & Dependent Child(ren) 149.60$ 6.60$
10 Adult with Medicare & Dependent Child(ren) 80.24$ 82.24$ FIRE (Exceed 40hrs/wk)
@ 93% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
166 but less than 169 work days
PC Description @93% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 174.51$ -$ 3 Two Adults & Dependent Child(ren) 261.73$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 54.04$ 238.04$ 6 One Adult with Medicare, One person w/o Medicare 124.04$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 145.25$ 129.25$ 8 Two Adults with Medicare & Dependent Child(ren) 75.81$ 476.81$ 9 Adult & Dependent Child(ren) 130.90$ -$
10 Adult with Medicare & Dependent Child(ren) 70.21$ 72.21$ FIRE (Exceed 40hrs/wk)
@ 94% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
169 but less than 172 work days
PC Description @94% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 149.58$ -$ 3 Two Adults & Dependent Child(ren) 224.34$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 46.32$ 230.32$ 6 One Adult with Medicare, One person w/o Medicare 106.32$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 124.50$ 108.50$ 8 Two Adults with Medicare & Dependent Child(ren) 64.98$ 465.98$ 9 Adult & Dependent Child(ren) 112.20$ -$
10 Adult with Medicare & Dependent Child(ren) 60.18$ 62.18$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 48 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 95% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
172 but less than 175 work days
PC Description @95% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 124.65$ -$ 3 Two Adults & Dependent Child(ren) 186.95$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 38.60$ 222.60$ 6 One Adult with Medicare, One person w/o Medicare 88.60$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 103.75$ 87.75$ 8 Two Adults with Medicare & Dependent Child(ren) 54.15$ 455.15$ 9 Adult & Dependent Child(ren) 93.50$ -$
10 Adult with Medicare & Dependent Child(ren) 50.15$ 52.15$ FIRE (Exceed 40hrs/wk)
@ 96% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
175 but less than 178 work days
PC Description @96% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 99.72$ -$ 3 Two Adults & Dependent Child(ren) 149.56$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 30.88$ 214.88$ 6 One Adult with Medicare, One person w/o Medicare 70.88$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 83.00$ 67.00$ 8 Two Adults with Medicare & Dependent Child(ren) 43.32$ 444.32$ 9 Adult & Dependent Child(ren) 74.80$ -$
10 Adult with Medicare & Dependent Child(ren) 40.12$ 42.12$ FIRE (Exceed 40hrs/wk)
@ 97% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
178 but less than 181 work days
PC Description @97% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 74.79$ -$ 3 Two Adults & Dependent Child(ren) 112.17$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 23.16$ 207.16$ 6 One Adult with Medicare, One person w/o Medicare 53.16$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 62.25$ 46.25$ 8 Two Adults with Medicare & Dependent Child(ren) 32.49$ 433.49$ 9 Adult & Dependent Child(ren) 56.10$ -$
10 Adult with Medicare & Dependent Child(ren) 30.09$ 32.09$
9/22/2020 2021 FIRE CONTRIBUTION RATE AGE 60 - 64 (Exceed 40hrs/wk)
RATES/2021 RETIREE RATE CHARTS.xlsx 49 of 50Department of Employee Relations
City Hall, Room 706
FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan that is determined by the percentage formula during the period the retiree is less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the UHC Choice Plus (PPO) plan during the period after retirement the retiree is at least age 60 but less than age 65.
FIRE (Exceed 40hrs/wk)
@ 98% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
181 but less than 184 work days
PC Description @98% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 49.86$ -$ 3 Two Adults & Dependent Child(ren) 74.78$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 15.44$ 199.44$ 6 One Adult with Medicare, One person w/o Medicare 35.44$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 41.50$ 25.50$ 8 Two Adults with Medicare & Dependent Child(ren) 21.66$ 422.66$ 9 Adult & Dependent Child(ren) 37.40$ -$
10 Adult with Medicare & Dependent Child(ren) 20.06$ 22.06$ FIRE (Exceed 40hrs/wk)
@ 99% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
184 but less than 187 work days
PC Description @99% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 24.93$ -$ 3 Two Adults & Dependent Child(ren) 37.39$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 7.72$ 191.72$ 6 One Adult with Medicare, One person w/o Medicare 17.72$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 20.75$ 4.75$ 8 Two Adults with Medicare & Dependent Child(ren) 10.83$ 411.83$ 9 Adult & Dependent Child(ren) 18.70$ -$
10 Adult with Medicare & Dependent Child(ren) 10.03$ 12.03$ FIRE (Exceed 40hrs/wk)
@ 100% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At least
187 work days
PC Description @100% UHC CHOICE PLUS (PPO) UHC CHOICE (EPO)1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare -$ -$ 3 Two Adults & Dependent Child(ren) -$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare -$ 184.00$ 6 One Adult with Medicare, One person w/o Medicare -$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) -$ -$ 8 Two Adults with Medicare & Dependent Child(ren) -$ 401.00$ 9 Adult & Dependent Child(ren) -$ -$
10 Adult with Medicare & Dependent Child(ren) -$ 2.00$
9/22/2020
DENTAL PLAN SINGLE PREMIUM
FAMILY PREMIUM
Delta Dental PPO 26.26$ 90.74$
Delta Dental EPO 46.82$ 152.96$
Care Plus 50.00$ 147.32$
FireDelta Dental PPO 31.50$ 90.24$
PoliceDelta Dental PPO 31.60$ 96.12$
2% COBRA Rate NOT included in these rates.2021 DENTAL PLAN RATES
