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FY2011 Full-Time Employee Premium Rates

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FY2011 Full-Time Employee Premium Rates Powered By Docstoc
					                 ACC Full-Time Employee Premium Rates
                                            Effective September 1, 2012
                                                     MEDICAL PREMIUMS
                                                                 You will pay per month…
   Your Choices
                                 Employee              Employee & Spouse          Employee & Child(ren)           Employee & Family
HealthSelect                        $0.00                    $269.20                     $180.24                        $449.44
Scott & White                       $0.00                    $265.06                     $177.46                        $442.52
Note: A new state law authorizes chargng higher premiums for people who continue to use tobacco starting
January 1, 2012. For more information, see the reverse side of this rate sheet.
                                                   BASIC TERM LIFE PREMIUM
                               Includes $5,000 term life with AD&D coverage. . . . . . . . ACC paid
                                                      DENTAL PREMIUMS
                                                                 You will pay per month…
   Your Choices
                                 Employee              Employee & Spouse          Employee & Child(ren)           Employee & Family
Dental Choice                       $0.00                     $23.58                       $33.02                        $56.60
Humana PPO)
(HumanaDHMO                         $0.00                     $8.53                        $11.93                        $20.46
                                             OPTIONAL TERM LIFE PREMIUMS
                                                      Cost per $1,000 of Annual Salary per month…
  Your Age Group
                                  Election I                Election II                 Election III                   Election IV
       15-29                         .00                        .05                         .10                            .15
       30-39                         .00                        .06                         .12                            .18
       40-44                         .00                        .08                         .16                            .24
       45-49                         .00                        .12                         .24                            .36
       50-54                         .00                        .19                         .38                            .57
       55-59                         .00                        .33                         .66                            .99
       60-64                         .00                        .57                         1.14                          1.71
       65-69                         .00                        .93                         1.86                          2.79
       70-74                         .00                       1.48                         2.96                          4.44
       75-79                         .00                       2.41                         4.82                          7.23
       80-84                         .00                       3.92                         7.84                         11.76
       85-89                         .00                       6.79                        13.58                         20.37
     90 & Over                          .00            10.57                   21.14                            31.71
Beginning at age 70, term life coverage is reduced to a percentage of your annual salary according to the following
table:
      Age 70 - 74 . . . . . . . . . . . . . . 65%                            Age 80 - 84 . . . . . . . . . . . . . . 25%
     Age 75 - 79 . . . . . . . . . . . . . . 40%                                        Age 85 - 89 . . . . . . . . . . . . . . 15%
                                                                                         Age 90 + . . . . . . . . . . . . . . . 10%
Note: Optional Term Life is limited to a maximum of $400,000 and includes equal AD&D coverage.
                                            DEPENDENT TERM LIFE PREMIUM
                        You pay $1.38 (includes $5,000 term life with AD&D coverage per dependent)
                           SHORT-TERM AND LONG-TERM DISABILITY PREMIUMS
                        Short-Term Disability . . . . . . . . . . . . . . $0.26/$100 of monthly salary
                        Long-Term Disability . . . . . . . . . . . . . . ACC paid (UNUM)
                      ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) PREMIUMS
                        Employee Only ($55,000) . . . . . . . . . . . ACC paid
                        Employee Only (Extra) . . . . . . . . . . . . . $0.02/$1,000 of coverage
                        Employee & Family . . . . . . . . . . . . . . . $0.04/$1,000 of coverage

  SOURCE: Employees Retirement System of Texas FY 2013                                                                       Rev 6/13/12
                                                    TOBACCO PREMIUMS
                    Member Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30.00
                    Spouse Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $30.00
                    Child (if member or spouse do not use tobacco) . . . . . . . . $30.00
                    Member + Spouse . . . . . . . . . . . . . . . . . . . . . . . . $60.00
                    Member + Child . . . . . . . . . . . . . . . . . . . . . . . . . . $60.00
                    Spouse + Child . . . . . . . . . . . . . . . . . . . . . . . . . . . $60.00
                    Member + Spouse + Child . . . . . . . . . . . . . . . . . . $90.00
Note:
 The charge for a child is the same regardless of how many children in the household use tobacco.
 The maximum additional premium is $90 per month.
                                 TEXFLEX FLEXIBLE SPENDING ACCOUNTS
                                                                    Annual Minimum Election        $180.00
                                                                    Annual Maximum Election        $5,000.00
          Health Care Account
                                                                        Annual Account Fee          $12.00
                                                                      Annual Debit Card Fee         $15.00
                                                                    Annual Minimum Election        $180.00
                                                                    Annual Maximum Election        $5,000.00
            Day Care Account
                                                                        Annual Account Fee          $12.00
                                                                      Annual Debit Card Fee         $15.00
Note:
 Annual account fee is per account.
 If debit card is elected, you will be charged only one $15.00 fee per year, even if you elect both accounts.

				
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posted:4/18/2013
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