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					Ch. 78, PL 2011                        Employee Benefits Contribution
                                          Calculation Worksheet
      10 Month Employee
      Calculate Premium Percentage
  1   Use the SEHBP Medical Premium (below) that applies to you:                       $   0.00
      Review the attached rate sheet for the plan you have selected, then locate the
      rate for the type of coverage you have: single, family or other
  2   Use the Percentage of Premium from Chart (attached):                                 0.00 %
      There are three charts attached representing single, family or other coverage.
      Using your annual salary, determine the proper rate for year one

  3   Calculate your Medical Plan Contribution:                                        $   0.00
      The formula provided will multiply the medical premium by the precentage,
      or #1 above times #2 above.
  4   Use the Rx rates below and enter the proper monthly amount:                      $   0.00
      Single: 157.77 Member/Spouse: $421.85, Family: $421.85 Parent/Child(ren):
      $212.67 (if you selected a HD med plan enter zero)
  5   Use the Percentage of Premium from Chart (attached):                                 0.00 %
      There are three charts attached representing single, family or other coverage.
      Using your annual salary, determine the proper rate for year one
  6   Calculate your Prescription Plan Contribution:                                   $   0.00
      The formula provided will multiply the prescription premium by the precentage,
      or #4 above times #5 above.

  7   Add lines #3 and #6 from above:                                                  $   0.00
      This will be your medical and prescription contribution spread over 12 months
      This is the amount spread over 10 months (for 10 month employees)                    0.00 ↙



      Calculate Salary Percentage
  8   Enter your annual salary:                                                        $   0.00

  9   Percentage rate as set by the state for salary percentage                            1.5 %

 10 Multiply your annual salary by the percentage of 1.5:                              $   0.00
      The formula provided will multiply #8 by #9


 11 Enter the number of months you work: 10                                                 10
      12 month employees

 12 Percentage of salary for benefits contribution:                                    $   0.00 ↙
      The formula provided will divide #10 by #11


      Your Monthly Benefit Contribution
 13 The formula will calculate the larger of line #7 or line #12                       $   0.00
      Your Benefit Contribution Per Pay
 14 This formula will calculate your per pay contribution                                  0.00
Ch. 78, PL 2011   Employee Benefits Contribution
                     Calculation Worksheet
SINGLE COVERAGE
       Salary Range     Year 1   Year 2   Year 3   Year 4
     less than 20,000   1.13%     2.25%    3.38%    4.50%
    20,000-24,999.99    1.38%     2.75%    4.13%    5.50%
    25,000-29,999.99    1.88%     3.75%    5.63%    7.50%
    30,000-34,999.99    2.50%     5.00%    7.50%   10.00%
    35,000-39,999.99    2.75%     5.50%    8.25%   11.00%
    40,000-44,999.99    3.00%     6.00%    9.00%   12.00%
    45,000-49,999.99    3.50%     7.00%   10.50%   14.00%
    50,000-54,999.99    5.00%    10.00%   15.00%   20.00%
    55,000-59,999.99    5.75%    11.50%   17.25%   23.00%
    60,000-64,999.99    6.75%    13.50%   20.25%   27.00%
    65,000-69,999.99    7.25%    14.50%   21.75%   29.00%
    70,000-74,999.99    8.00%    16.00%   24.00%   32.00%
    75,000-79,999.99    8.25%    16.50%   24.75%   33.00%
    80,000-94,999.99    8.50%    17.00%   25.50%   34.00%
     95,000 and over    8.75%    17.50%   26.25%   35.00%
FAMILY COVERAGE
     Salary Range     Year 1   Year 2   Year 3   Year 4
   less than 25,000   0.75%     1.50%    2.25%    3.00%
  25,000-29,999.99    1.00%     2.00%    3.00%    4.00%
  30,000-34,999.99    1.25%     2.50%    3.75%    5.00%
  35,000-39,999.99    1.50%     3.00%    4.50%    6.00%
  40,000-44,999.99    1.75%     3.50%    5.25%    7.00%
  45,000-49,999.99    2.25%     4.50%    6.75%    9.00%
  50,000-54,999.99    3.00%     6.00%    9.00%   12.00%
  55,000-59,999.99    3.50%     7.00%   10.50%   14.00%
  60,000-64,999.99    4.25%     8.50%   12.75%   17.00%
  65,000-69,999.99    4.75%     9.50%   14.25%   19.00%
  70,000-74,999.99    5.50%    11.00%   16.50%   22.00%
  75,000-79,999.99    5.75%    11.50%   17.25%   23.00%
  80,000-84,999.99    6.00%    12.00%   18.00%   24.00%
  85,000-89,999.99    6.50%    13.00%   19.50%   26.00%
  90,000-94,999.99    7.00%    14.00%   21.00%   28.00%
  95,000-99,999.99    7.25%    14.50%   21.75%   29.00%
 100,000-109,999.99   8.00%    16.00%   24.00%   32.00%
  110,000 and over    8.75%    17.50%   26.25%   35.00%
Member & Spouse/Partner or Parent& Child(ren) Coverage
   Salary Range       Year 1              Year 2         Year 3   Year 4
 less than 25,000     0.88%               1.75%           2.63%    3.50%
25,000-29,999.99      1.13%               2.25%           3.38%    4.50%
30,000-34,999.99      1.50%               3.00%           4.50%    6.00%
35,000-39,999.99      1.75%               3.50%           5.25%    7.00%
40,000-44,999.99      2.00%               4.00%           6.00%    8.00%
45,000-49,999.99      2.50%               5.00%           7.50%   10.00%
50,000-54,999.99      3.75%               7.50%          11.25%   15.00%
55,000-59,999.99      4.25%               8.50%          12.75%   17.00%
60,000-64,999.99      5.25%              10.50%          15.75%   21.00%
65,000-69,999.99      5.75%              11.50%          17.25%   23.00%
70,000-74,999.99      6.50%              13.00%          19.50%   26.00%
75,000-79,999.99      6.75%              13.50%          20.25%   27.00%
80,000-84,999.99      7.00%              14.00%          21.00%   28.00%
85,000-99,999.99      7.50%              15.00%          22.50%   30.00%
100,000 and over      8.75%              17.50%          26.25%   35.00%
           2012                   Direct 10            Direct 15     Direct 1525   Direct 2030
Single                              561.55               534.58          518.82        487.59
Member/Spouse                       1123.1              1069.16         1037.64        975.19
Family                             1403.88              1336.45         1297.06       1218.99
Parent/Child                        831.09               791.18          767.85        721.64


* These rates are effective 1/1/2012, and are subject to change on 1/1/2013
        2012                Aetna HMO          Aenta 1525       Aetna 2030
Single                           547.56             505.62          475.45
Member/Spouse                   1095.12            1011.23          950.89
Family                           1368.9            1264.04         1188.62
Parent/Child                     810.39             748.31          703.66


* These rates are effective 1/1/2012, and are subject to change on 1/1/2013
            2012            Cigna HMO       Cigna 1525        Cigna 2030
Single                          550.57           508.4            478.06
Member/Spouse                  1101.14         1016.79            956.12
Family                         1376.43         1271.00           1195.15
Parent/Child                    814.84          752.42            707.53




* These rates are effective 1/1/2012, and are subject to change on 1/1/2013
                                NJ Direct 10          Aetna               Cigna
                 2012               HD1500           HD1500             HD1500

Single                              583.32            571.91             574.36
Member/Spouse                      1166.63           1143.82            1148.72
Family                             1458.29           1429.77            1435.91
Parent/Child                         863.3            846.42             850.05



These rates include the medical and prescription plans.
Be sure to enter zero in the worksheet for the prescription plan.

* These rates are effective 1/1/2012, and are subject to change on 1/1/2013

				
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