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

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Subs Coverage 1st. $1,500 Deductible Employee Only 27 Employee & Spouse 9 Employee and Children 16 Employee and Family 24 Coverage 1st. $1,000 Deductible Employee Only 50 Employee & Spouse 23 Employee and Children 19 Employee and Fami~y 35 PPO . $500 Deductible Employee Only 29 Employee & Spouse 16 Employee and Children 11 Employee and Family 16 PPo . $300 Deductible Employee Only 25 Employee & Spouse 17 Employee and Children 6 Employee and Family 49 Total Monthly Funding Total Annual Funding Employee/Employer % 372 City of La Porte Premium and Contribution Projection Effective January 1, 2006 Proposed Premiums and Contributions Total Employer Employee Premium Contribution Contributions : $514.65 $500.00 $14.65 $605.00 $500.00 $105.00 $595.24 $500.00 $95.24 $620.69 $500.00 $120.69 $522.70 $500.00 $22.70 $630.34 $500.00 $130.34 $620.07 $500.00 $120.07 $655.60 $500.00 $155.60 $550.23 $500.00 $50.23 $665.74 $500.00 $165.74 $655.15 $500.00 $155.15 $685.32 $500.00 $185.32 $579.14 $500.00 $79.14 $725.79 $500.00 $225.79 $715.99 $500.00 $215.99 $739.56 $500.00 $239.56 $231,253 $186,000 $45,253 $3,200,000 $2,232,000 $543,032 100% 70% 17% The Welch COmpany l=und Subsidy $11.43 $81.90 $74.29 $94.14 $17.71 $101.67 $93.65 $121.37 $39.18 $129.28 $121.02 $144.55 $61.73 $176.12 $168.47 $186.86 $35,298 $423,575 13% Total EE Contribution ....:.'" $26.08 $186.90 $169.53 $214.83 $40.41 $232.01 $213.72 $276.97 $89.41 $295.02 $276.17 $329.87 $140.87 $401.91 $384.46 $426.42 $80,551 $966,607 30% Total Premium wi Contributions & SubsidY $526.08 $686.90 $669.53 $714.83 $540.41 $732.01 $713.72 $776.97 $589.41 $795.02 $776.17 $829.87 $640.87 $901.91 $884.46 $926.42 $266 551 $3,198,607 c