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<br />City of La Porte <br />Premium and Contribution Worksheet <br />Effective January 1, 2007 <br /> <br />Subs <br /> <br />Coverage 1st - $1,500 Deductible <br />Employee Only 24 <br />Employee & Spouse 13 <br />Employee and Children 17 <br />Employee and Family 24 <br /> <br />Coverage 1st - $1,000 Deductible <br />Employee Only 50 <br />Employee & Spouse 23 <br />Employee and Children 20 <br />Employee and Family 35 <br /> <br />PPO - $500 Deductible <br />Employee Only 26 <br />Employee & Spouse 19 <br />Employee and Children 10 <br />Employee and Family 21 <br /> <br />PPO - $300 Deductible <br />Employee Only 22 <br />Employee & Spouse 14 <br />Employee and Children 4 <br />Employee and Family 52 <br /> <br />Total Monthly Funding <br /> <br />Total Annual Funding <br />Employer/Employee % <br /> <br />374 <br />- <br /> <br />. 15% increase from 2006 EE Contribution <br />.. Employer Supplement equates to: <br />- Non-participatory revenue <br />- Allocated expenses <br />- One-time revenues + expenses <br />- Fund balance contribution <br /> <br />2007 <br />Employer <br />Contribution <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$575.00 <br />$215,050 <br />$2,580,600 <br />77% <br /> <br />2007 Employe <br />Supplement" <br />$3.17 <br />$22.71 <br />$20.60 <br />$26.10 <br />$4.91 <br />$28.19 <br />$25.97 <br />$33.65 <br />$10.86 <br />$35.84 <br />$33.55 <br />$40.08 <br />$17.11 <br />$48.83 <br />$46.71 <br />$51.81 <br />$10,020 <br />$120,240 <br />4% <br /> <br />2007 <br />Employee <br />Contribution' <br />$16.85 <br />$120.75 <br />$109.53 <br />$138.79 <br />$26.11 <br />$149.89 <br />$138.08 <br />$178.94 <br />$57.76 <br />$190.60 <br />$178.42 <br />$213.12 <br />$91.01 <br />$259.66 <br />$248.39 <br />$275.49 <br />$53,284 <br />$639,408 <br />19% <br /> <br />Exhibit II <br /> <br />Total 2007 <br />Premium <br />$595.02 <br />$718.46 <br />$705.12 <br />$739.89 <br />$606.01 <br />$753.08 <br />$739.05 <br />$787.59 <br />$643.63 <br />$801.44 <br />$786.97 <br />$828.19 <br />$683.13 <br />$883.49 <br />$870.10 <br />$902.30 <br />$278,354 <br />$3,340,249 <br />100% <br /> <br />D <br />