HomeMy WebLinkAbout2020-83 - Res. Amending Res. 102-19 Determining the Teamsters 2019 Health Insurance Contributions RESOLUTION NO. Zy2O $3
AMEND RESOLUTION NO. 102-19 DETERMINING THE TEAMSTERS GENERAL SERVICES 2019 HEALTH
INSURANCE CONTRIBUTIONS AND THE TEAMSTERS GENERAL SERVICES, COMMUNITY AND FAMILY`
HEALTH AND ALL OTHER COUNTY'S PEBB MEMBERS 2020 HEALTH INSURANCE CONTRIBUTIONS
WHEREAS, RCW 36.40.080 states that the Board of County Commissioners shall fix and determine each
item of the budget separately and shall by resolution adopt the budget; and
WHEREAS, RCW 36.16.070 states that the Board shall fix the benefit compensation of all employees; and
WHEREAS,the Board determined that the County's contribution towards health insurance premiums for
Teamsters General Services employees shall increase by $52 per month for a total contribution of
$1;258 (One thousand two hundred and fifty eight dollars) per month, effective July 1, 2019; and
WHEREAS,the Board determined that the County's contribution towards health insurance premiums for
Elected Officials and eligible Non-Represented employees shall increase by $52 per month-for a total
contribution of $1,310 (One thousand three hundred and ten dollars) per month, effective January 1,
2020; and
WHEREAS, the Board has determined that the County's contribution towards health insurance
premiums for Elected Officials, eligible Non-Represented employees, and also those members of the
Collective Bargaining Agreements who participate in PEBB medical insurance to utilize the pooling
method; and
NOW THEREFORE BE IT RESOLVED, effective July 1, 2019, the Board of County Commissioners does
hereby establish the County's health insurance contribution rate for Teamsters General Services
Collective Bargaining Agreement recently ratified with allowance for a retro to be effective July 1, 2019
utilizing the pooling method, and resulting in a distribution as follows:
$937.58 per month for those individuals enrolled in PEBB medical as an employee only (no
dependent coverage). This contribution also covers dental, vision, and basic life insurance.
$1,443.03 per month those individuals enrolled in PEBB medical as an employee with one or
more dependents. This contribution also covers dental, vision, and basic life insurance.
NOW THEREFORE BE IT RESOLVED, effective January 1, 2020, the Board of County Commissioners does.
hereby establish the County's health insurance contribution rate for Teamsters General Services and
Community Family Health Collective Bargaining Agreements recently ratified with allowance for a retro
to be effective January 1; 2020 utilizing the pooling method, and resulting in a distribution as follows:
$963.08 per month for those individuals enrolled in PEBB medical as an employee only (no
dependent coverage). This contribution also covers dental, vision, and basic life insurance.
$1,602.67 per month those individuals enrolled in PEBB medical as an employee with one or
more dependents. This contribution also covers dental, vision, and basic life insurance.
NOW THEREFORE BE IT RESOLVED, effective November 1, 2020, the Board of County Commissioners
does hereby establish the revised County's health insurance contribution rate for any Collective
Bargaining Agreements in place and ratified on January 1, 2020 (Deputy Prosecutors, Probation, Public
Defenders), Elected Officials, and Non Represented employees utilizing the revised pooling method, and
resulting in a new distribution as follows:
$963.08 per month per Employee for those individuals enrolled in PEBB medical as an employee
only (no dependent coverage). This contribution also covers dental, vision, and basic life
insurance. There shall be no retro payment for 2020.
$1,602.67 per month per Employee for those individuals enrolled in PEBB medical as an
employee with one or more dependents. This contribution also covers dental, vision, and basic
life insurance. There shall be no retro payment for 2020.
Approved this day of mlotr 2020
BOARD OF COUNTY COMMISSIONERS
Sharon Trask, hairperson
Kevin Sh t y, mmissioner
Ra y NeatfVrlin, Commissioner
Attest:
McKenzie Sn th, Clerk of the Board
Approved
Tim Whitehead, Chie eputy Prosecutor
cc: Financial Services, Payroll
Human Resources
All Elected Officials and Department Heads
PEBB
Effective July 1, 2019 County Pooling Contribution Calculations
NON-UNION EMPLOYEES,ELECTED OFFICIALS,GENERAL SERVICES,PROBATION,COMMUNITY FAMILY HEALTH,DEPUTY PROSECUTORS,&PUBLIC DEFENDERS
Counts as of September 26,2018
1209 Contrlbut�on per Employee ,
Commtimty Fmily 8e Heaifih,Deputy
Fprosecutoxs;PubhcDefendei%;Elected $1,258 00_•i minus $937.58 Highest Employee only premium = $320.42
2019 Contr-ibution pei Employee, '
lq*ni l S4vices;_8i Probation _ $1!,25$00 minus $937.58 Highest Employee only premium = $320.42
�'Cammumty 8e Family Health,Depufiy_.,
P�osecufiors Public Defenders,Elected�� •
kOffi als;&NU _
$320.42 X 24 Employee only premiums $7,690.08
General Services_&°Probation _,_';. $320.42 X 28 Employee only premiums = $8,971.76
1 Medical Waiver $1,258.00 minus $152.62 PEBB dental,vision,life only amount = $1,105.38
1 Medical Waiver $1,258.00 minus $152.62 PEBB dental,vision,life only amount = $1,105.38
Total pooling per month for dependent coverage = $18 872 60
$18,872.60 divided by 102 Employee+Dependent Coverages = $185.03
2019&nfributxon per Employee
�Comrnun�ty-Family&Healfili,Deputy ,
Prosecutors;Publie•Defen&rs,EO;:&
NU :1
+ $185.03 Pooling amount per Employee+Dependent Coverages $1,443 03'
,20�19 ContriliutionperEmployee '. . •
General Service§.&Probattgn u $1,258 00._; + $185.03 Pooling amount per Employee+Dependent Coverages = $1,4,43 03`
Pooled County Contribution for Employee+Dependent Coverage =
Pooled County Contribution for Employee only Coverage
Monthly Annuallndiv # Annual
Premium #Months Premium Employees Premium
Co`irrinuriity Family.,&Health;Dpity
p Ikosecutors,.PublicDefendeis,Elected"
Officials&Non-,-Union, $ I,258 00 12 $15,096.00 95 $1,434,120.00
D 7
2019 Contribution per Employee
�Gerieral`3_ervices 8c Probation $ 1258 00 12 $15,096.00 61 $ 920,856.00
156 $2,354,976.00
GENERALSERVICES
PEBB-Medical Benefits&WCIF-Dental Vision Life Benefits 2019
the Cbu -
MY prernturn contribution using the,pooling mPtt .effecWe July 1�2019 by Resolution_All pooled @ 2019 rate,of$1258
Copays Annual Deductibles Max out-of-packet Employee EE/Spouse EE/Children Full Family
Kaiser Permanente WA(Group PREMIUM $806.64 $1,546.05 $1,361.20 $2,100.62
Health Classic) $15 Primary Caro $175/Person $2,000/Penon WCIF DENTAL VISION LIFE $130.94 $130.94 $130.94 $130.94
$30Specialist $525/Family $4,000/Family PREMIUM TOTAL $937.58 $1,676.99 $1,492.14 $2,231.56
COUNTY POOLED CONTRIBUTION $937.58 $1,443.03 $1,443.03 $1,443.03
EMPLOYEE PAYS(Payroll Deduction) $0.00 S233.96 $49.11 $788.53
Kaiser Permanente WA(Group PREMIUM $729.50 $1,391.79 $1,226.21 $1,888.50
Health Value) $30 Primary Cam 5250/Person $3,000/Person WCIF DENTAL VISION LIFE $130.94 $130.94 $130.94 $130.94
$50 Specialist 5750/Family $6,000/Family PREMIUM TOTAL $860.44 $1,522.73 $1,357.15 $2,019.44
COUNTY POOLED CONTRIBUTION $937.58 $1,443.03 $1,443.03 $1,443.03
EMPLOYEE PAYS(Payroll Deduction) None $79.70 None $576.41
Kaiser Permanente WA(Group PREMIUM $673.69 $1,274.71 $1,139.04 $1,681.72
Health CDHP) 10%u/PrimaryCarc $1,400/Pcrson $5,100/Person WCIF DENTAL VISION LIFE _ $130.94 $130.94 $130.94 $130.94
10%Specialist $2,800/Family $10,200/Family PREMIUM TOTAL $804.63 $1,405.65 $1,269.98 $1,812.66
COUNTY POOLED CONTRIBUTION $937.58 $1,443.03 $1,443.03 $1,443.03
EMPLOYEE PAYS(Payroll Deduction) None None None $369.63
Kaiser Permanente WA(Group PREMIUM $676.46 $1,285.69 $1,133.38 $1,742.62
Health Sound Choice) o Primary Care $125/Pcrson $2,000/Person WCIF DENTAL VISION LIFE $130.94 $130.94 $130.94 $130.94
15%Specialist $375Family $4,000/Family PREMIUM TOTAL $807.40 $1,416.63 $1,264.32 $1,873.56
(Must live or work in Snohomish,King, COUNTY POOLED CONTRIBUTION $937.58 $1,443.03 $1,443.03 $1,443.03
Pierce or Thurston County) EMPLOYEE PAYS(Payroll Deduction) None- None None $43053
Uniform Medical Plan Classic PREMIUM $748.10 $1,428.97 $1,258.75 $1,939.63
15%Primary Care $250/Person $2,000/Person WCIF DENTAL VISION LIFE $130.94 $130.94 $130.94 $130.94
15%Specialist $750/Family $4,000/Family PREMIUM TOTAL $879.04 $1,559.91 $1,389.69 $2,070.57
COUNTY POOLED CONTRIBUTION $937.58 $1,443.03 $1,443.03 $1,443.03
EMPLOYEE PAYS(Payroll Deduction) None $116.88 None $627.54
Uniform Medical Plan CDHP PREMIUM $673.79 $1,274.90 $1,139.21 $1,681.99
15%Primary Care $1,400/Person $4,200/Person WCIF DENTAL VISION LIFE, $130.94 $130.94 $130.94 $130.94
15%Specialist $2,800/Family $8,400/Family PREMIUMTOTAL $804.73 $1,405.84 $1,270.15 $1,812.93
COUNTY POOLED CONTRIBUTION $937.58 $1,443.03 $1,443.03 $1,443.03
EMPLOYEE PAYS(Payroll Deduction) None None None $369.90
Uniform Medical Plan PLUS or PREMIUM $691.32 $1,315.43 $1,159.40 $1,783.50
Uniform Medical Plan PlusUW 0%Primary Care $125/Person $2,000/Person
Medicine ACN WCIF DENTAL VISION LIFE $130.94 $130.94 $130.94 $130.94
(Must live in Snohomish,King,Kitsap,Pierce,
Spokane,Yakima,Skagit or Thurston County) 15%Specialist $375/Family $4,000/Family PREMIUM TOTAL $822.26 $1,446.37 $1,290.34 $1,914.44
COUNTY POOLED CONTRIBUTION $937.58 $1,443.03 $1,443.03 $1,443.03
EMPLOYEE PAYS(Payroll Deduction) None $3.34 None $471.41
Tobacco Use Surcharge $25.00 $25.00 $25.00 $25.00
Spouse Waiver Premium Surcharge $0.00 $50.00 $0.00 $50.00
DENTAL VISION LIFE
WCIF Delta Dental VSP$175 jBasIc $24,000 _
Willamette(Managed Care&their facilities)Reduce premium by$6.75 Frame IDependent $1,000
J
PEBB
Effective Jan 01,2020 County Pooling Contribution Calculations
NON-UNION EMPLOYEES,ELECTED OFFICIALS,GENERAL SERVICES,PROBATION,COMMUNITY FAMILY HEALTH,DEPUTY PROSECUTORS,&PUBLIC DEFENDERS
Counts as of October 14,2019
208 Contri�utiori per Employee
General$eryiees
349.00'-' minus $963.08 Highest Employee only premium = $346.92-
2019 Contribution per Employee-
Com&Family Health&Deputy
Prosecutors $1,310.00 minus $963.08 Highest Employee only premium $346.92
2020 Contribution per-Employee
Probation;Public Defenders;Elected' ..
Officials&Non-Represenfed�, _ $1;3'_10.00 minus $963.08 Highest Emp loyee only premium = $346.92
20T8 ConWbutian per EmpTpyee
General;.Seryices $346.92 X 29 Employee only premiums = $10,060.68
2019 Contribution per Employee-
Com&Family Health&Deputy
Prosecutors $346.92 X 9 Employee only premiums = $3,122.28
2020 Contribution per.Employee:- ,
Probation„Public.Defenders,`Elected
Officials.&.N6n-Represented ' $346.92 X 23 Employee only premiums = $7,979.16
1.I4edic4l,W2iver $1,310.00 minus $154.36 PEBB dental,vision,life only amount = $1,155.64
.:Medical JWaiver - $1,310.00 minus $154.36 PEBB dental,vision,life only amount = $1,155.64
1,Medical;Waiver. $1,310.00 minus $154.36 PEBB dental,vision,life only amount = $1,155.64
2lbledioal Waiver $1,310.00 minus $154.36 PEBB dental,vision,life only amount = $1,155.64
3''Ivledieal',Waiver $1,310.00 minus $154.36 PEBB dental,vision,life only amount = $1,155.64
4 Medical Waiver,' $1,310.00 minus $154.36 IPEBB dental,vision,life only amount = $1,155.64
Total pooling Der month for dependent coverage = $28,095.96
$28,095.96 divided by 96 Employee+Dependent Coverages = $292.67
201'8-Contribution per Employee-:
Gerieral.Services. $1,31.0.00.i + $292.67 Pooling amount per Employee+Dependent Coverages = $4,602.67
2019 Contribution per Employee
Com&Family Health&Deputy
Prosecutors $_1,310.00 + $292.67 Pooling amount per Employee+De endent Coverages = $1,602.67
20266. tribution:perEmptoyee: ,.
Probation,:Public Defenders,Elected
Officials&;Non-Represented $1,310 00 + $292.67 Pooling amount per Employee+De Dependent Coverages = $1,602,67
Pooled County Contribution for Employee+Dependent Coverage =
Pooled County Contribution for Employee only Coverage = $9.05..08
IvIonflay Annual In iv
Premium #Months Premium
2018 Contribution per-Epployee,
General Services:• _ $1:,6Q2 67 ' 12 $. 1,9,232.00
------------
2019 Contribution per Employee- —�
Com&Family Health&Deputy
Prosecutors $1,602.67 12 $ 19,232.00
2020 Contribution pei:Employee
P-r`obation;Public-Defenders-Elected': -':'• '.
Officials,&Non Represented $1,602:67 12 $: 19232:00-
2020 Contribution for'all Employee
Only Coverage $963.08 12 $11,556.96
PUBLIC DEFENDERS,PROBATION,ELECTED OFFICIALS& NON REPRESENTED
PEBB-Medical and Dental 2020
The County premlum;contrlhutionvsingthe pooling method effet;t Nbyemberl,2020,hy,Resolut_ion /111'pooled @ 2020 rate of$1330,
Copays Amoral Deductibles Max out-of-pocket Employee EE/Spouse EE/Children Full Family
Kaiser Permanente WA PREMIUM $913.45 $1,672.54 $1,482.77 $2,241.85
(Group Health Classic) $15 Primary Care $175/Person $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 . $1,602.67
$30 Specialist $525/Family $4,000/Family EMPLOYEE PAYS(Payroll Deduction) None $69.87 None $639.18
Kaiser Permanente WA PREMIUM $837.01 $1,519.66 $1,349.00 $2,031.65
(Group Health Value) $30 Primary Care $250/Person $3,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
$50 Specialist $750/Family $6,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $428.98
Kaiser Permanente WA PREMIUM ' $771.46 $1,383.40 $1,245.00 $1,798.62
(Group Health CDHP) I00/,/Primary Care $1,400/Person $5,100/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
10%Specialist S2,800/Family $10,200/Family EMPLOYEE PAYS(Payroll Deduction) None,- None None $195.95
Kaiser Permanente WA PREMIUM $779.79 $1,405.22 $1,248.87 $1,874.30
(Group Health Sound Choice) O Primary care $125/Person $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
(Must live or work in Snohomish,King,
Pierce or Thurston County) 15%Specialist $375 Family $4,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $271.63
Uniform Medical Plan Classic PREMIUM $841.02 $1,527.67 $1,356.01 $2,042.67
15%Primary Care $250/Person $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
15%Specialist $750/Family $4,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $440.00
Uniform Medical Plan CDHP PREMIUM $769.65 $1,379.78 $1,241.83 $1,793.64
15%Primary Cam $1,400/Person $4,200/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
15%Specialist $2,800/Family $8,400/Family EMPLOYEE PAYS(Payroll Deduction) None None None $190.97
Uniform Medical Plan PLUS or PREMIUM $806.27 $1,458.18 $1,295.18 $1,947.12
Uniform Medical Plan Plus UW Medicine ACN 0%Primary Care $125/Person $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
(Must live in Snohomish,Icing,Kilsap,
Pierce,Spokane,Yakima,Skagit or Thurston 15%Specialist $375/Family S4,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $344.45
County)
Tobacco Use Surcharge $25.00 $25.00 $25.00 / $25.00
Spouse Waiver Premium Surcharge $0.00 $50.00 $0.00 $50.00
Medical Waived $154.36 $154.36 $154.36 $154.36
DENTAL Deductibles Max out-of-pocket VISION BASIC LIFE AND AD&D Insurance
Uniform Dental Group#3000 $50/Person$150/Family You pay amounts Included in medical plan Basic Life $35,000 Basic AD&D $5,000
Delta Dental PPO over$1,750 May enroll in supplemental Term Life Insurance without providing
Delta Care Group#3100 No General Plan You pay any amount over$150 every 24 evidence of insurability if enrolled no later than 60 days after
NONE months for frames,lenses,contacts and becoming eligible.
Managed care w/limited dentists Maximum fitting fees combined.Exception:for LIMP
Willamette Dental No General Plan Classic,you pay any amount over$65 for 1 May enroll in optional LTD within 31 days of initial eligibility for
NONE Managed care&their facilities Maximum contact lens fitting fees. PEBB benefits.After 31 days must also complete Evidence of
Insurability form.
COMMUNITY FAMILY HEALTH
PEBS-Medical and Dental 2020
The County premium contribution using the pooling method,effective January 1,2020,by Resolution .All pooled @ 2020 rate of$1310
Copays Annual Deductibles Max out-of-pocket Employee EE/Spouse EE/Children Full Family
Kaiser Permanente WA PREMIUM $913.45 $1,672.54 $1,482.77 $2,241.85
(Group Health Classic) $15 Primary Care $175/Person $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
$30 Specialist $525/Family $4,000/Family EMPLOYEE PAYS(Payroll Deduction) None $69.87 None $639.18
Kaiser Permanente WA PREMIUM $837.01 $1,519.66 .$1,349.00 $2,031.65
(Group Health Value) $3 0 Primary Care $250/Person $3,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
$50 Specialist $750/Family $6,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $428.98
Kaiser Permanente WA PREMIUM $771.46 $1,383.40 $1,245.00 $1,798.62
(Group Health CD HP) 10%/Primary Care $1,400/Person $5,100/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
10%Specialist $2,800/Family $10,200/Family EMPLOYEE PAYS(Payroll Deduction) None None None $195.95
Kaiser Permanente WA PREMIUM $779.79 $1,405.22 $1,248.87 $1,874.30
(Group Health Sound Choice) O Primary can, $125/Person $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
(Must live or work in Snohomish,King, '
Pierce or Thurston County) 15%Specialist $375 Family $4,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $271.63
Uniform Medical Plan Classic PREMIUM $841.02 $1,527.67 $1,356.01 $2,042.67
15%Primary Care $250/Person $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
15%Specialist $750/Family $4,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $440.00
Uniform Medical Plan CDHP PREMIUM $769.65 $1,379.78 $1,241.83 $1,793.64
15%Primary Care $1,400/Person $4,200/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
15%Specialist $2,800/Family -_$8,400/17amily EMPLOYEE PAYS(Payroll Deduction) None None None $190.97
Uniform Medical Plan PLUS or PREMIUM $806.27 $1,458.18 $1,295.18 $1,947.12
Uniform Medical Plan Plus UW Medicine ACN 0%Primary Care S125/1erson $2,000/Person COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
(Must live in Snohomish,King,Kitsap,
Pierce,Spokane,Yakima,Skagit or Thurston 15%Specialist $375/17amily $4,000/Family EMPLOYEE PAYS(Payroll Deduction) None None None $344.45
County)
Tobacco Use Surcharge $25.00 $25.00 $25.00 $25.00
Spouse Waiver Premium Surcharge $0.00 $50.00 $0.00 $50.00
Medical Waived $154.36 $154.36 $154.36 $154.36
DENTAL Deductibles Max out-of-pocket VISION BASIC LIFE AND AD&D Insurance
Uniform Dental Group#3000 $50/Person$150/1'amily You pay amounts Included In medical plan Basic Life $35,000 Basic AD&D $5,000
Delta Dental PPO over$1,750 May enroll In supplemental Term Ufe Insurance without providing
Delta Care Group#3100 No General Plan you pay any amount over$150 every 24 evidence of Insurability if enrolled no later than 60 days after
NONE months for frames,lenses,contacts and becoming eligible.
Managed care w/limited dentists Maximum.' fitting fees combined.Exception:for UMP
Willamette Dental No General Plan Classic,you pay any amount over$65 for May enroll In optional LTD within 31 days of Initial eligibility for
NONE contact lens fitting fees. PEBB benefits.After 31 days must also complete Evidence of
Managed care&their facilities Maximum Insurability form.
DEPUTY PROSECUTING ATTORNEYS
PEBB-Medical Benefits&WCIF-Dental Vision life Benefits 2020
The County premium contribution using the pooling method,effective November 1,2020,by Resolution .All pooled @ 2020 rate of$1310
Copays Annuol Dcductibles Mox out-o&pockel Employee EE/Spouse EE/Children Full Family
Kaiser Permanente WA(Group PREMIUM $826.77 $1,585.86 $1,396.09 $2,155.17
Health Classic) S15PrimeryCara $175/Pcrson S2,000/Pcrson WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
$30 Specialist $525/Family S4,000/Fomily PREMIUM TOTAL $961.32 $1,720.41 $1,530.64 $2,289.72
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None $117.74 None $687.05
Kaiser Permanente WA(Group PREMIUM $750.33 $1,432.98 $1,262.32 $1,944.97
Health Value) $30Pi-,yCo. S250/Pcrson $3,000/1?crson WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
$50 Spcaialist S750/Fxmily $6,000IPnmily PREMIUM TOTAL $884.88 $1,567.53 $1,396.87 $2,079.52
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None S476.85
Kaiser Permanente WA(Group PREMIUM $684.78 $1,296.72 $1,158.32 $1,711.94
HealthCDHP) 10'/Wrimarycare $1,400mcrson $5,1001P-on WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
10%spceialist $2,80o/Fomily $10,200/%amily PREMIUM TOTAL $819.33 $1,431.27 $1,292.87 $1,846.49
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $243.82
i
Kaiser Permanente WA(Group PREMIUM $693.11 $1,318.54 $1,162.19 $1,797.62
Health Sound Choice) OPrimarycora $125mcrson si,000mcrson WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
15%Spcafolist $375Fomily $4,000/Family PREMIUM TOTAL $827.66 $1,453.09 $1,296.74 $1,922.17
(Must live or work in Snohomish,King, COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
Pierce or Thurston County) EMPLOYEE PAYS(Payroll Deduction) None None None $319.50
Uniform Medical Plan Classic PREMIUM $754.34 $1,440.99 $1,269.33 $1,955.99
15 Pi-,yCo. $250menon $2,000mcrson WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
15%Spccialisl $750?amily $4,000/Family PREMIUM TOTAL $888.89 $1,575.54 $1,403.88 $2,090.54
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $487.87
Uniform Medical Plan CDHP PREMIUM $682.97 $1,293.10 $1,155.15 $1,706.96
15%Primary Co. $1,400/Pcmon $4,200/Pcraon WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
15%Spccialin $2,800/Family $8,400/Family PREMIUMTOTAL $817.52 $1.427.65 $1,289.70 $1,841.51
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None S238.84
Uniform Medical Plan PLUS or PREMIUM $719.59 $1,371.50 $1,208.53 $1,860.44
Uniform Medical Plan Plus UW
Medicine ACN 0%PrimnryCara $125/Parson $2,000/Pcmon WCIF DENTAL VISION LIFE $134.55 $134.55, $134.55 $134.55
(Must liva in Snohomish,King,Kitsap,Pisrac- IS%S ccialisl $375/Fomil $4,000/Fomi1
Spokane,Yakima,Skagit or Thurston County) P y y PREMIUM TOTAL $854.14 $1,506.05 $1,343.08 $1,994.99
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $392.32
Tobacco Use Surcharge $25.00 $25.00 $25.00 $25.00
Spouse Waiver Premium Surcharge $0.00 $50.00 $0.00 $50.00
DENTAL VISION LIFE
WCIF Delta Dental-Reduced prelum by$D.16 VSP$175 Basic $24,000
Wlllamette(Managed Care&their facilities) Frame IDependent $1,000
GENERAL SERVICES.
PEBB-Medical Benefits&WCIF-Dental Vision Life Benefits 2020
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Copays Annual Deductibles Max out-of-pocketEmployee EE/Spouse EE/Children Full Family
Kaiser Permanente WA(Group PREMIUM $826.77 $1,585.86 $1,396.09 $2,155.17
Health Classic) $15 Primary Care $175/Person $2,000/Person WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
$30 Specialist $525/Family $4,000/Family PREMIUM TOTAL $961.32 $1,720.41 $1,530.64 $2,289.72
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None $117.74 None $687.05
Kaiser Permanente WA(Group PREMIUM $750.33 $1,432.98 $1,262.32 $1,944.97
Health Value) $30 Primary Care $250/Person $3,000/Person WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
$50 Specialist $750/Family $6,000/Family PREMIUM TOTAL $884.88 $1,567.53 $1,396.87 $2,079.52
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $476.85
Kaiser Permanente WA(Group PREMIUM $684.78 $1,296.72 $1,158.32 $1,711.94
Health CDHP) 10%/Primary Care $1,400/Person $5,100/Person WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
10%Specialist S2,800/Family $10,200/Family PREMIUM TOTAL $819.33 $1,431.27 $1,292.87 $1,846.49
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $243.82
Kaiser Permanente WA(Group PREMIUM $693.11 $1,318.54 $1,162.19 $1,787.62
Health Sound Choice) 0 Primary Car. $125/Pcrson S2,000/Pcrson ' WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
15/Specialist $375Family $4,000/Family PREMIUMTOTAL $827.66 $1,453.09 $1,296.74 $1,922.17
(Must live or work in Snohomish,King, COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
Pierce of Thurston County) EMPLOYEE PAYS(Payroll Deduction) None None None $319.50
Uniform Medical Plan Classic PREMIUM $754.34 $1,440.99 $1,269.33 . $1,955.99
15%Primary Carc $250/Person $2,000/Pcrson WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134,55
15%Specialist $750/Family $4,000/Family PREMIUM TOTAL $888.89 $1,575.54 $1,403.88 $2,090.54
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $487.87
i
Uniform Medical Plan CDHP PREMIUM $682.97 $1,293.10 $1,155.15 $1,706.96
15%Primary Cam $1,400/Person $4,200/Person WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
15%Specialist $2,800/Family $8,400/Family PREMIUM TOTAL $817.52 $1,427.65 $1,289.70 $1,841.51
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $238.84
Uniform Medical Plan PLUS or PREMIUM $719.59 $1,371.50 $1,208.53 $1,860.44
Uniform Medical Plan Plus UW
Medicine ACN 0%Primary Cam S125/Pcrson $2,000/Person WCIF DENTAL VISION LIFE $134.55 $134.55 $134.55 $134.55
(Must live in Snohomish,King,Kitsap,Picnic,
Spokane,Yakima,Skagit or Thurston County) 15%Specialist $375/Family $4,000/Family PREMIUM TOTAL $854.14 $1,506.05 $1,343.08 $1,994.99
COUNTY POOLED CONTRIBUTION $963.08 $1,602.67 $1,602.67 $1,602.67
EMPLOYEE PAYS(Payroll Deduction) None None None $392.32
Tobacco Use Surcharge $25.00 $25.00 $25.00 $25.00
Spouse Waiver Premium Surcharge $0.00 $50.00 $0.00 $50.00
DENTAL VISION LIFE
WCIF - Delta Dental-Reduce premium by$0.16 1 VSP$175 JBasic •$24,000
Willamette(Managed Care&their facilities) Frame IDependent $1,000