O-2006-2781-B (original in 2004)

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Schedule B 25% Coverage 1st - $1,500 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family Coverage 1st - $1,000 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family PPO - $500 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family PPO - $300 Deductible Employee Only Employee & Spouse Employee and Children Employee and Family Total Monthly Funding Total Annual Funding Employee/Employer % Subs 360 City of La Porte Premium and Contribution Projection Effective January 1, 2005 23 8 8 22 Proposed Premiums and Contributions Current Total Employer Employee Employee Premium Contribution Contributions Contribution Change $452.20 $429.17 $18.04 $0.00 $18.04 $581.64 $429.17 $132.47 $104.00 $28.47 $530.40 $429.17 $101.24 $86,67 $14.57 $632.86 $429.17 $190.69 $112.67 $78.02 $487.88 $429.17 $33.70 $0.00 $33.70 $627.51 $429.17 $174.34 $104.00 $70.34 $572.24 $429.17 $138.07 $86.67 $51 .40 $682.77 $429.17 $200.60 $112.67 $87.93 $508.39 $429.17 $54.23 $0.00 $54.23 $653.91 $429,17 $200.74 $104.00 $96.74 $596.31 $429.17 $162.15 $86.67 $75.48 $711.49 $429.17 $225.32 $112.67 $112.65 $554.31 $429.17 $100.14 $0.00 $100.14 $712.95 $429.17 $258.79 $104.00 $154.79 $650.16 $429.17 $215.99 $86.67 $129.32 $775.73 $429.17 $316.56 $112.67 $203.89 $219,551 $154,500 $55,444 $23,929 $31,515 $2,634,610 $1,854,001 $665,328 $287,151 $378,176 100% 70% 25% , 54 6 6 16 22 23 24 58 33 13 13 31 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 Company Per Check $8.33 $61.14 $46.72 $88.01 $15.55 $80.46 $63.72 $92.58 $25.03 $92.65 $74.84 $103.99 $46.22 $119.44 $99.69 $146.10 A