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The Welch Comoan Assumptions: 1. Humana Smart Suite plan design. 2. Rate differentials based on Humana book of business. 3. Enrollment assumptions based on Humana plan experience. 4. Employee and total premiums are based on previously stated projections of expected costs. Schedule C 20% Subs Coverage 1st - $1,500 Deductible Employee Only 23 Employee & Spouse 8 Employee and Children 8 Employee and Family 22 .overage 1st - $1,000 Deductible Employee Only 54 Employee & Spouse 6 Employee and Children 6 Employee and Family 16 PPO - $500 Deductible Employee Only 22 Employee & Spouse 23 Employee and Children 24 Employee and Family 58 PPO - $300 Deductible Employee Only 33 Employee & Spouse 13 Employee and Children 13 Employee and Family 31 e 360 Total Monthly Funding Total Annual Funding Employee/Employer % Proposed Premiums and Contributions Current Total Employer Employee Employee Premium Contribution Contributions Contribution Change I $452.20 $429.17 $14.65 $0.00 $14.65 $581.64 $429.17 $105.00, $104.00 $1.00 $530.40 $429.17: $95.24 $86.67 $8.57 $632.86 $429.17 $120.69 $112.67 $8.02 , $487.88 $429.17 ~ $22.70 $0.00 $22.70 $627.51 $429.17 ' $130.34 $104.00 $26.34 $572.24 $429.17; $120.07. $86.67 $33.40 $682.77 $429.17. $155.60' $112.67 $42.93 : $508.39 $429.17, $50.23: $0.00 $50.23 $653.91 $429.171 $165.74 $104.00 $61.74 $596.31 $429.17; $155.15, $86.67 $68.48 $711.49 $429.17; $185.32' $112.67 $72.65 $554.31 $429.17: $79.14i $0.00 $79.14 $712.95 $429.171 $225.79' $104.00 $121.79 $650.16 $429.17! $215.99' $86.67 $129.32 $775.73 $429.17: $239.56 $112.67 $126.89 I j i I $219,551 $154.500: $44,982, $23,929 $21,053 $2,634,610 $1.854,001 $539,787: $287,151 $252,636 100% 70% 20% I $36.53 $104.21 $99.69 $110.57 Per Check $23.18 $76.50 $71.61 $85.53 $10.48 $60.16 $55.42 $71.82 $6.76 $48.46 $43.96 $55.70 City of La Porte Premium and Contribution Projection Effective January 1. 2005