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UNIVERSITY SYSTEM OF GEORGIA

Insurance Premium Rates as of January 1, 2011



HEALTH INSURANCE MONTHLY PREMIUMS



PPO - HDHP

PPO Consumer

PPO - HDHP PPO - HDHP Consumer PPO PPO

Choice

PPO - HDHP Alternative Consumer Choice PPO Alternative Consumer

Alternative

Network Choice Alternative Network Choice

Network Network



Employee Only 27.70 25.24 55.40 50.50 166.68 151.94 222.26 202.60

Employer Contribution 249.28 227.24 249.28 227.24 388.92 354.52 388.92 354.52

Total Premium 276.98 252.48 304.68 277.74 555.60 506.46 611.18 557.12

Employee + Child 48.40 44.12 96.82 88.24 300.02 273.48 400.08 364.70

Employer Contribution 435.60 397.10 435.60 397.10 700.02 638.14 700.02 638.14

Total Premium 484.00 441.22 532.42 485.34 1000.04 911.62 1100.10 1002.84

Employee + Spouse 56.16 51.20 112.34 102.40 350.02 319.06 466.72 425.44

Employer Contribution 505.50 460.80 505.50 460.80 816.72 744.50 816.72 744.50

Total Premium 561.66 512.00 617.84 563.20 1166.74 1063.56 1283.44 1169.94

Employee w/Family 76.88 70.06 153.74 140.14 483.34 440.60 644.46 587.46

Employer Contribution 691.80 630.64 691.80 630.64 1127.78 1028.06 1127.78 1028.06

Total Premium 768.68 700.70 845.54 770.78 1611.12 1468.66 1772.24 1615.52

BlueChoice BlueChoice Kaiser

Kaiser HMO

HMO HMO HMO

Consumer

Consumer

Choice

Choice

Employee Only 123.96 196.26 122.36 193.74

Employer Contribution 289.24 289.24 285.50 285.50 A Tobacco Surcharge

Total Premium 413.20 485.50 407.86 479.24 will be added to your monthly

premium if you use Tobacco

Employee + Child 223.14 353.28 220.24 348.70 products. The $50 Tobacco

Employer Contribution 520.62 520.62 513.90 513.90 Surcharge applies to any

Total Premium 743.76 873.90 734.14 862.60 Tobacco use.



Employee + Spouse 260.32 412.18 256.96 406.84

Employer Contribution 607.40 607.40 599.56 599.56

Total Premium 867.72 1,019.58 856.52 1,006.40



Employee w/Family 359.50 569.20 354.84 561.80

Employer Contribution 838.80 838.80 827.92 827.92

Total Premium 1,198.30 1,408.00 1,182.76 1,389.72





DENTAL INSURANCE MONTHLY PREMIUM



Employee 30.84

Employee + Child 58.58

Employee + Spouse 61.66

Family 98.66



LONG TERM DISABILITY RATE: 0.44 per thousand of annual salary



SUPPLEMENTAL LIFE INSURANCE RATES



Under 25 0.09 Rates are for each $1,000 of

25-29 0.10 insurance and include a rider for

30-34 0.12 Accidental Death and

35-39 0.13 Dismemberment.

40-44 0.15

45-49 0.20 Dependant Life Insurance Monthly

50-54 0.29 4.70 ($10,000 on each eligible dependant)

55-59 0.52

60-64 0.80

65-69 1.55

70 and Over 2.46 (No AD&D)



RETIREMENT

Employee Contribution CSU Contribution

Teachers Retirement System of Georgia 5.53% Pretax 10.28%

Optional Retirement Plan 5% Pretax 9.24% 10/13/10



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