O-2004-2777 - Laserfiche WebLink

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City of La Porte Premium and Contribution Projection Effective January 1, 2005 Proposed Premiums and Contributions --current Employee Contribution Per Check $6.76 $48.46 $43.96 $55.70 e $10.48 $60.16 $55.42 $71.82 $22.70 $26.34 $33.40 $42.93 $0.00 $104.00 $86.67 $112.67 $23.18 $76.50 $71.61 $85.53 $50.23 $61.74 $68.48 $72.65 $0.00 $104.00 $86.67 $112.67 $36.53 $104.21 $99.69 $110.57 $79.14 $121.79 $129.32 $126.89 $0.00 $104.00 $86.67 $112.67 e $21,053 $252,636 an 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. The Welch Com Change $14.65 $1.00 $8.57 $8.02 $23,929 $287,151 Schedule C 20% $0.00 $104.00 $86.67 $112.67 Employer Contribution $429.17 $429.17 $429.17 $429.17 Total Premium $452.20 $581.64 $530.40 $632.86 Subs 23 8 8 22 Coverage 1st - $1,500 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family $487.88 $627.51 $572.24 $682.77 54 6 6 16 Coverage 1st - $1,000 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family $429.17 $429.17 $429.17 $429.17 $508.39 $653.91 $596.31 $711.49 22 23 24 58 PPO - $500 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family $429.17 $429.17 $429.17 $429.17 $554.31 $712.95 $650.16 $775.73 33 13 13 31 PPO - $300 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family 360 54,500 $1,854,001 70% $1 $219,551 $2,634,610 1'00% Total Monthly Funding Total Annual Funding Employee/Employer %