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					MONTHLY CONTRIBUTIONS EFFECTIVE OCTOBER 1, 2008
Revised 3/13/08

NEW MEXICO PUBLIC SCHOOLS INSURANCE AUTHORITY
(NMPSIA) THE STANDARD: BASIC LIFE ACCIDENTAL DEATH & DISMEMBERMENT THE STANDARD: ADDITIONAL LIFE (Employee, Spouse & Children) and AD&D (Employee Only) Person's Rate per Age $1,000 < 30 $0.04 30-39 $0.06 40-44 $0.08 45-49 $0.12 50-54 $0.22 55-59 $0.34 60-64 $0.52 65-69 $0.78 70 & over $1.02 Child(ren) $.24/mo.

$10,000 Life/AD&D $25,000 Life/AD&D $50,000 Life/AD&D

$1.20 per month $3.00 per month $6.00 per month

THE STANDARD: LONG TERM DISABILITY 30 Day Wait $.58 per $100 payroll 60 Day Wait $.34 per $100 payroll 90 Day Wait $.28 per $100 payroll

HEALTH COVERAGES

Single

Two Party

Family

Blue Cross Blue Shield - High Option

$458.40

$871.78

$1,164.36

Blue Cross Blue Shield - Low Option

$385.04

$732.28

$978.10

Presbyterian - High Option

$370.70

$778.38

$1,037.92

Presbyterian - Low Option

$311.40

$653.84

$871.86

United Concordia Dental - High Option

$24.84

$47.30

$74.34

United Concordia Dental - Low Option

$12.44

$23.68

$37.16

Davis Vision Plan (Please see the reverse side for Monthly Payroll Deductions for Health Coverages.)

$6.26

$10.48

$14.14

NMPSIA CONTRIBUTIONS OCTOBER 1, 2008 Less than $15,000 25%/75% $114.60 $343.80 $217.94 $653.84 $291.08 $873.28 $96.26 $288.78 $183.06 $549.22 $244.52 $733.58 $92.66 $278.04 $194.58 $583.80 $259.48 $778.44 $77.84 $233.56 $163.46 $490.38 $217.96 $653.90 $6.20 $18.64 $11.82 $35.48 $18.58 $55.76 $3.10 $9.34 $5.92 $17.76 $9.28 $27.88 $1.58 $4.68 $2.64 $7.84 $3.54 $10.60 $15,000 through $19,999 30%/70% $137.52 $320.88 $261.52 $610.26 $349.30 $815.06 $115.50 $269.54 $219.68 $512.60 $293.42 $684.68 $111.20 $259.50 $233.50 $544.88 $311.38 $726.54 $93.42 $217.98 $196.14 $457.70 $261.56 $610.30 $7.44 $17.40 $14.18 $33.12 $22.30 $52.04 $3.72 $8.72 $7.10 $16.58 $11.14 $26.02 $1.88 $4.38 $3.14 $7.34 $4.24 $9.90 $20,000 through $24,999 35%/65% $160.44 $297.96 $305.12 $566.66 $407.52 $756.84 $134.76 $250.28 $256.30 $475.98 $342.32 $635.78 $129.74 $240.96 $272.42 $505.96 $363.26 $674.66 $108.98 $202.42 $228.84 $425.00 $305.14 $566.72 $8.68 $16.16 $16.56 $30.74 $26.02 $48.32 $4.34 $8.10 $8.28 $15.40 $13.00 $24.16 $2.20 $4.06 $3.68 $6.80 $4.94 $9.20 $25,000 and Over 40%/60% $183.36 $275.04 $348.70 $523.08 $465.74 $698.62 $154.02 $231.02 $292.90 $439.38 $391.24 $586.86 $148.28 $222.42 $311.34 $467.04 $415.16 $622.76 $124.56 $186.84 $261.54 $392.30 $348.74 $523.12 $9.94 $14.90 $18.92 $28.38 $29.74 $44.60 $4.98 $7.46 $9.46 $14.22 $14.86 $22.30 $2.50 $3.76 $4.18 $6.30 $5.66 $8.48

MONTHLY COST SHARING BASED ON SALARY BCBS High Option Single (employee deduction) Single (district contribution) Two party (employee deduction) Two party (district contribution) Family (employee deduction) Family (district contribution) Single (employee deduction) Single (district contribution) Two party (employee deduction) Two party (district contribution) Family (employee deduction) Family (district contribution) Single (employee deduction) Single (district contribution) Two party (employee deduction) Two party (district contribution) Family (employee deduction) Family (district contribution) Single (employee deduction) Single (district contribution) Two party (employee deduction) Two party (district contribution) Family (employee deduction) Family (district contribution) Dental High Option United Concordia Single (employee deduction) Single (district contribution) Two party (employee deduction) Two party (district contribution) Family (employee deduction) Family (district contribution) Single (employee deduction) Single (district contribution) Two party (employee deduction) Two party (district contribution) Family (employee deduction) Family (district contribution) Single (employee deduction) Single (district contribution) Two party (employee deduction) Two party (district contribution) Family (employee deduction) Family (district contribution)

BCBS Low Option

Presbyterian High Option

Presbyterian Low Option

Dental Low Option United Concordia

Davis Vision


				
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