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MONTHLY BASIC GROUP INSURANCE PREMIUMS by HC120831021540

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									                             MONTHLY BASIC GROUP INSURANCE PREMIUMS
                                                           2010
Employee premiums for the Basic Group Insurance Program, including health, term life and accidental insurance are
based on salary and coverage selected as indicated in the following tables.

          PPO – “Preferred Provider Option” - Blue Cross/Blue Shield of Tennessee
          POS – “Point of Service Plan” - Cigna East
          HMO –“Health Maintenance Organization” – United Healthcare

 COVERAGE             ANNUAL SALARY                           MONTHLY PREMIUMS
                                                             Employee                          Employer
                                                  PPO          POS       HMO


01Single          Less than $14,999.99         $107.62       $ 85.63          $ 79.24          $ 430.48
  Family          (Term Life $20,000)          $269.00       $214.17          $198.20          $1074.75
  Split                                        $161.18       $128.34          $118.76          $ 644.27

02Single          $15,000.00 - $17,499.99      $108.06       $ 86.07          $ 79.68          $ 430.48
  Family          (Term Life $22,000)          $269.47       $214.64          $198.67          $1074.75
  Split                                        $161.62       $128.78          $119.20          $ 644.27

03Single          $17,500.00 - $19,999.99      $108.73       $ 86.74          $ 80.35          $ 430.48
  Family          (Term Life $25,000)          $270.20       $215.37          $199.40          $1074.75
  Split                                        $162.32       $129.48          $119.90          $ 644.27

04Single          $20,000.00 - $22,499.99      $109.84       $ 87.85          $ 81.46          $ 430.48
  Family          (Term Life $30,000)          $271.40       $216.57          $200.60          $1074.75
  Split                                        $163.43       $130.59          $121.01          $ 644.27

05Single          $22,500.00 - $24,999.99      $110.62       $ 88.63          $ 82.24          $ 430.48
  Family          (Term Life $33,500)          $272.24       $217.41          $201.44          $1074.75
  Split                                        $164.23       $131.39          $121.81          $ 644.27

06Single          $25,000.00 - $27,499.99      $111.39       $ 89.40          $ 83.01          $ 430.48
  Family          (Term Life $37,000)          $273.07       $218.24          $202.27          $1074.75
  Split                                        $165.04       $132.20          $122.62          $ 644.27

07Single          $27,500.00 - $29,999.99      $112.17       $ 90.18          $ 83.79          $ 430.48
  Family          (Term Life $40,500)          $273.93       $219.10          $203.13          $1074.75
  Split                                        $165.85       $133.01          $123.43          $ 644.27

08Single          $30,000.00 - $32,499.99      $112.95       $ 90.96          $ 84.57          $ 430.48
  Family          (Term Life $44,000)          $274.76       $219.93          $203.96          $1074.75
  Split                                        $166.65       $133.81          $124.23          $ 644.27

09Single          $32,500.00 - $34,999.99      $113.73       $ 91.74          $ 85.35          $ 430.48
  Family          (Term Life $47,500)          $275.60       $220.77          $204.80          $1074.75
  Split                                        $167.43       $134.59          $125.01          $ 644.27

10Single         $35,000.00 and over           $114.28      $ 92.29            $ 85.90          $ 430.48
  Family         (Term Life $50,000)           $276.20      $221.37            $205.40          $1074.75
  Split                                        $168.02      $135.18            $125.60          $ 644.27
Note: Split Coverage covers the employee and eligible dependent children, excluding spouse, where both employee and
spouse are employed by the State.

10/2009

								
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