8/13/2019 POMCO

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2014 EMPLOYEE HEALTH BENEFIT CONTRIBUTION INFORMATIONunion Employees payroll deductions are based on their current union contracts.Nonrepresented Management and Elected or Appointed officials payroll deductions are based ontheir annual salary as per Board Act No 41-2010.To see what your payroll deduction will be for 2OI4 first look at Chart A to determine what yourpercentage of premium is. Then go to chart B to see your payroll deduction amount.

CHART A

CHART B

pleasenote:lftheHMo premiumcostishigherthanthePoMCopremiumcostemployeeswhoareenrolledinthe HMo will berequiredtopaythedifference.Thisisin additionto theircountyHealth Plan (PoMCo) standard deduction. This additional cost is already included in theabove employee contributions amounts.

PERCENTAGE OF PREMIUM CONTRIBUTION REQUIRED:OBA MEMBERS PRIOR TO JULY 9, 2O]-2 14%:OBA MEMBERS AFTER JULY 9, 2012 20%l^AIt\/IINAI IN\/FSTIGATORS o%.SFA o%NON.REPRESENTED MGMT SALARY $60,000 S12O,OOO 20%NTJRSES Effective 2014 512.50 per person up to $50.00 per pay period.POLICE lndividual r.I25% Familv 3.125%( of highest Police Officer salary)SOA MEMBERS 14%I TAMSIIR MEMBERS PRIOR TO JUNE 4, 2012 ro%II AMSII I{ MTMI]LRS Af I ER JUNE 4, 2012 20%

ITINN MOIINTS PER 24 PAY PERIOT PBA % of highest salary NYSNA Health Plan

HEALTH PLAN MONTHTYPREMIUM

o% to% L4% L5% 20% lndividual 1.125%Number of DeductionEnrolled Per PaY MonthlYMembers Period TotalFamilv 3.t25% 0e rson S12. so 52s.00

POMCO INDIVIDUAL s 725.80 s 36.29 S so.gr 5 s4.44 5 72.58 5 47.31 people s2s.00 ss0.00POMCO FAMILY 5 ,r,914.30 s 5 9s.72 5 134.00 5 t43.sl 5 r9L.43 $ 131.59 3 reople s37.s0 57s.00HIP INDIVIDUAL 5 803.76 S 38.98 5 7s.27 S ss.zg 5 93.42 5 111.s6 5 so'ss to a max of 4 :eople sso.00 s100.00iltP t/\MttY 5 r,969.21 5 21.46 5 L23 17 S 161.46 s 171.03 s 218.89 s 159.0s^I INA INDIVIDUAL NY 5 1,036.18 S 1ss.19 s 191.48 s 206.00 5 209.63 5 227.77 s 202.s6A[ INA t]AMILY NY 5 2,893.43 s 489.57 s s8s.28 5 ozz.s-t s 633.14 S 681.00 S 621.1 6\FTNA INDIVIDUAL NJ 5 837.83 S s6.02 5 92.31 S r.06.83 s 110.46 s 128.60 s 103.39\ETNA FAMILY NJ 5 2,361.s3 5 223.62 5 319.34 5 3s1.62 S 367.19 $ 41s.0s S gss.zrAETNA INDIVIDUAL CT s 1,044.s9 s 159.40 I 19s.69 5 210.21 s 213.84 5 231.98 5 206.71AETNA FAMILY CT s 2,930.16 s s07.93 5 603.6s s 641.93 S 6si-.so 5 699.36 5 639.s2NYSNA Benefit Plan 5 1,343.s0