MISSOURI WESTERN STATE COLLEGE - DOC by X9RE37qi

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									   MISSOURI WESTERN STATE UNIVERSITY
           Blue Cross Blue Shield Medical Plans
       Effective January 1, 2012 – December 31, 2012
                      Active Retirees

             UNDER 65 YEARS OLD

                   Blue-Care HMO


                                   Monthly Retiree
          Coverage Level            Contribution
    Retiree                           $568.26
    Retiree + Spouse                 $1,091.06
    Retiree + Child(ren)              $931.95
    Family                           $1,397.93


             Preferred-Care Blue PPO

                                    BASE PLAN
                                   Monthly Retiree
           Coverage Level           Contribution
     Retiree                          $497.97
     Retiree + Spouse                 $956.10
     Retiree + Child(ren)             $816.66
     Family                          $1,225.01


                                   BUY UP PLAN
                                   Monthly Retiree
           Coverage Level           Contribution
     Retiree                          $609.57
     Retiree + Spouse                $1,170.39
     Retiree + Child(ren)             $999.71
     Family                          $1,499.45


Preferred-Care Blue/BlueSaver (High Deductible)


                                   Monthly Retiree
           Coverage Level           Contribution
     Retiree                          $422.90
     Retiree + Spouse                 $811.97
     Retiree + Child(ren)             $693.56
     Family                          $1,040.34

								
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