Classified Sutter Health Plus Classified

CAP:

SHHMO

SHP LG Standard $20-$0 TxxxSO TxxxOA EE+Spouse EE+Children 1,336.00 1,016.00 119.75 119.75 20.40 20.40 1,476.15 1,156.15 12.00 12.00 17,713.80 13,873.80 6,790.00 6,790.00 10,923.80 7,083.80 910.32 590.32

Txxx00 Coverage: EE Only Medical 668.00 Dental 119.75 VSP 20.40 Monthly 808.15 x 12 mos 12.00 Annual 9,697.80 less cap 6,790.00 over/under cap 2,907.80 12-PAY 242.32 11-PAY

264.35

993.07

6,790.00 ($565.83 per month) 2015/16

643.98

SHMID

TxxxSA EE+Family 1,570.00 119.75 20.40 1,710.15 12.00 20,521.80 6,790.00 13,731.80 1,144.32 1,248.35

SHHDP

SHP LG HDHP 20%0$2,500 (HSAEligible) $2,500/$5,000 Txxx00 TxxxSO TxxxOA TxxxSA Coverage: EE Only EE+Spouse EE+Children EE+Family Medical 425.00 850.00 645.00 996.00 Dental 119.75 119.75 119.75 119.75 VSP 20.40 20.40 20.40 20.40 Monthly 565.15 990.15 785.15 1,136.15 x 12 mos 12.00 12.00 12.00 12.00 Annual 6,781.80 11,881.80 9,421.80 13,633.80 less cap 6,790.00 6,790.00 6,790.00 6,790.00 over/under cap (8.20) 5,091.80 2,631.80 6,843.80 12-PAY (0.68) 424.32 219.32 570.32 11-PAY

(0.75)

462.89

239.25

622.16

SHP LG HMO (HSAEligible) $1,500-$3,000 Txxx00 TxxxSO TxxxOA TxxxSA Coverage: EE Only EE+Spouse EE+Children EE+Family Medical 479.00 958.00 728.00 1,123.00 Dental 119.75 119.75 119.75 119.75 VSP 20.40 20.40 20.40 20.40 Monthly 619.15 1,098.15 868.15 1,263.15 x 12 mos 12.00 12.00 12.00 12.00 Annual 7,429.80 13,177.80 10,417.80 15,157.80 less cap 6,790.00 6,790.00 6,790.00 6,790.00 over/under cap 639.80 6,387.80 3,627.80 8,367.80 12-PAY 53.32 532.32 302.32 697.32 11-PAY

58.16

580.71

329.80

760.71

Classified Western Health Advantage Classified

CAP:

WHHMO

WHA - Premier 20 TxxxSO TxxxOA EE+Spouse EE+Children 1,220.00 927.00 119.75 119.75 20.40 20.40 1,360.15 1,067.15 12.00 12.00 16,321.80 12,805.80 6,790.00 6,790.00 9,531.80 6,015.80 794.32 501.32

Txxx00 Coverage: EE Only Medical 610.00 Dental 119.75 VSP 20.40 Monthly 750.15 x 12 mos 12.00 Annual 9,001.80 less cap 6,790.00 over/under cap 2,211.80 12-PAY 184.32 11-PAY

201.07

866.53

6,790.00 ($565.83 per month) 2015/16

546.89

WHMID TxxxSA EE+Family 1,433.00 119.75 20.40 1,573.15 12.00 18,877.80 6,790.00 12,087.80 1,007.32 1,098.89

WHHDP

WHA-Western 2800/ High Ded $2800/$5600 w/HSA Txxx00 TxxxSO TxxxOA TxxxSA Coverage: EE Only EE+Spouse EE+Children EE+Family Medical 424.00 848.00 644.00 994.00 Dental 119.75 119.75 119.75 119.75 VSP 20.40 20.40 20.40 20.40 Monthly 564.15 988.15 784.15 1,134.15 x 12 mos 12.00 12.00 12.00 12.00 Annual 6,769.80 11,857.80 9,409.80 13,609.80 less cap 6,790.00 6,790.00 6,790.00 6,790.00 over/under cap (20.20) 5,067.80 2,619.80 6,819.80 12-PAY (1.68) 422.32 218.32 568.32 11-PAY

(1.84)

460.71

238.16

619.98

WHA-Western 1800/ High Ded $1800/$3600 w/HSA

Txxx00 Coverage: EE Only Medical 512.00 Dental 119.75 VSP 20.40 Monthly 652.15 x 12 mos 12.00 Annual 7,825.80 less cap 6,790.00 over/under cap 1,035.80 12-PAY 86.32 11-PAY

94.16

TxxxSO EE+Spouse 1,024.00 119.75 20.40 1,164.15 12.00 13,969.80 6,790.00 7,179.80 598.32

TxxxOA EE+Children 778.00 119.75 20.40 918.15 12.00 11,017.80 6,790.00 4,227.80 352.32

TxxxSA EE+Family 1,201.00 119.75 20.40 1,341.15 12.00 16,093.80 6,790.00 9,303.80 775.32

652.71

384.35

845.80

Classified Kaiser CAP:

Classified

6,790.00 ($565.83 per month) 2015/16

#600559D

Kaiser $20 Co-Pmt, RX: $10 Generic/$25 Brand w/Chiro Txxx00 TxxxSO TxxxOA TxxxSA Coverage: EE Only EE+Spouse EE+Children EE+Family Medical 742.00 1,484.00 1,128.00 1,744.00 Dental 119.75 119.75 119.75 119.75 VSP 20.40 20.40 20.40 20.40 Monthly 882.15 1,624.15 1,268.15 1,884.15 x 12 mos 12.00 12.00 12.00 12.00 Annual 10,585.80 19,489.80 15,217.80 22,609.80 less cap 6,790.00 6,790.00 6,790.00 6,790.00 over/under cap 3,795.80 12,699.80 8,427.80 15,819.80 12-PAY 316.32 1,058.32 702.32 1,318.32 11-PAY

345.07

1,154.53

766.16

1,438.16

#602214

Kaiser High Deductible Plan w/HSA $2000/$4000 Txxx00 TxxxSO TxxxOA TxxxSA Coverage: EE Only EE+Spouse EE+Children EE+Family Medical 474.00 948.00 721.00 1,113.00 Dental 119.75 119.75 119.75 119.75 VSP 20.40 20.40 20.40 20.40 Monthly 614.15 1,088.15 861.15 1,253.15 x 12 mos 12.00 12.00 12.00 12.00 Annual 7,369.80 13,057.80 10,333.80 15,037.80 less cap 6,790.00 6,790.00 6,790.00 6,790.00 over/under cap 579.80 6,267.80 3,543.80 8,247.80 12-PAY 48.32 522.32 295.32 687.32 11-PAY

52.71

569.80

322.16

749.80

Insurance Rates-CAPS.pdf

Coverage: EE Only EE+Spouse EE+Children EE+Family Coverage: EE Only EE+Spouse EE+Children EE+Family. Medical 668.00 1,336.00 1,016.00 1,570.00 ...
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