Tipton County Schools 2017 Employee Insurance Benefits: State of Tennessee Group Insurance Program Premiums and Payments PAYMENTS WILL UPDATE TO THE NEW RATE ON THE 11/30/2016 PAYROLL
PLANS
CARRIER
CIGNA LOCAL PLUS OR BCBS STANDARD HEALTH CIGNA LOCAL PLUS OR BCBS LIMITED HEALTH CIGNA LOCAL PLUS OR BCBS HEALTHSAVINGS/CDHP CIGNA LOCAL PLUS OR BCBS NO PARTNERSHIP PROMISE CIGNA LOCAL PPO PLUS OR BCBS
Employee Only
PAYROLL CODE 102
Employee Only
101
$7,020.00
$6,318.00
$702.00
$35.10
Employee Only
122
$5,112.00
$4,600.80
$511.20
$25.56
Employee Only
131
$4,596.00
$4,136.40
$459.60
$22.98
$7,452.00
$6,706.80
$745.20
$37.26
PARTNERSHIP HEALTH
CIGNA LOCAL PLUS OR BCBS STANDARD HEALTH CIGNA LOCAL PLUS OR BCBS LIMITED HEALTH CIGNA LOCAL PLUS OR BCBS HEALTHSAVINGS/CDHP CIGNA LOCAL PLUS OR BCBS NO PARTNERSHIP PROMISE CIGNA LOCAL PPO PLUS OR BCBS
Employee + Child(ren)
104
$11,292.00
$8,469.00
$2,823.00
$141.15
Employee + Child(ren)
103
$11,580.00
$8,685.00
$2,895.00
$144.75
Employee + Child(ren)
124
$8,424.00
$6,318.00
$2,106.00
$105.30
Employee + Child(ren)
132
$7,584.00
$5,688.00
$1,896.00
$94.80
$11,892.00
$8,919.00
$2,973.00
$148.65
PARTNERSHIP HEALTH
Employee + Spouse
106
$13,356.00
$10,017.00
$3,339.00
$166.95
Employee + Spouse
105
$13,680.00
$10,260.00
$3,420.00
$171.00
Employee + Spouse
126
$9,960.00
$7,470.00
$2,490.00
$124.50
Employee + Spouse
133
$8,964.00
$6,723.00
$2,241.00
$112.05
$14,556.00
$10,917.00
$3,639.00
$181.95
PARTNERSHIP HEALTH
CIGNA LOCAL PLUS OR BCBS STANDARD HEALTH CIGNA LOCAL PLUS OR BCBS LIMITED HEALTH CIGNA LOCAL PLUS OR BCBS HEALTHSAVINGS/CDHP CIGNA LOCAL PLUS OR BCBS NO PARTNERSHIP PROMISE CIGNA LOCAL PPO PLUS OR BCBS
PREMIUM LEVEL
Employee Only
Employee + Child(ren)
Employee + Spouse
ANNUAL PREMIUM $6,852.00
TCS COST PER YEAR $6,166.80
EMPLOYEE COST 20 PAYMENTS PER YEAR PER YEAR $685.20 $34.26
CIGNA LOCAL PLUS OR BCBS STANDARD HEALTH CIGNA LOCAL PLUS OR BCBS LIMITED HEALTH CIGNA LOCAL PLUS OR BCBS HEALTHSAVINGS/CDHP CIGNA LOCAL PLUS OR BCBS NO PARTNERSHIP PROMISE CIGNA LOCAL PPO PLUS OR BCBS
Employee + Spouse + Children
108
$17,796.00
$13,347.00
$4,449.00
$222.45
Employee + Spouse + Children
107
$18,240.00
$13,680.00
$4,560.00
$228.00
Employee + Spouse + Children
128
$13,272.00
$9,954.00
$3,318.00
$165.90
Employee + Spouse + Children
134
$11,940.00
$8,955.00
$2,985.00
$149.25
$18,996.00
$14,247.00
$4,749.00
$237.45
PARTNERSHIP HEALTH
CIGNA LOCAL PLUS OR BCBS STANDARD HEALTH CIGNA LOCAL PLUS OR BCBS LIMITED HEALTH CIGNA LOCAL PLUS OR BCBS HEALTHSAVINGS/CDHP CIGNA LOCAL PLUS OR BCBS NO PARTNERSHIP PROMISE CIGNA LOCAL PPO PLUS OR BCBS
2 TCS Employees + Children
110
$17,796.00
$15,126.60
$2,669.40
$133.47
2 TCS Employees + Children
109
$18,240.00
$15,504.00
$2,736.00
$136.80
2 TCS Employees + Children
130
$13,272.00
$11,281.20
$1,990.80
$99.54
2 TCS Employees + Children
135
$11,940.00
$10,149.00
$1,791.00
$89.55
3 TCS Employees + Children
$18,996.00
$16,146.60
$2,849.40
$142.47
PRESCRIPTION DRUGS
Bundled with Health
$0.00
PARTNERSHIP HEALTH
CAREMARK
Employee + Spouse + Children
Dental and Vision Plans and Costs DENTAL PPO DENTAL PREPAID
METLIFE CIGNA
Employee Only Employee Only
202 201
$268.44 $155.88
0 $268.44 0 $155.88
$13.42 $7.79
DENTAL PPO DENTAL PREPAID
METLIFE CIGNA
Employee + Child(ren) Employee + Child(ren)
204 203
$617.28 $323.64
0 $617.28 0 $323.64
$30.86 $16.18
DENTAL PPO DENTAL PREPAID
METLIFE CIGNA
Employee + Spouse Employee + Spouse
206 205
$507.84 $276.24
0 $507.84 0 $276.24
$25.39 $13.81
DENTAL PPO DENTAL PREPAID
METLIFE CIGNA
Employee + Family Employee + Family
208 207
$993.60 $379.80
0 $993.60 0 $379.80
$49.68 $18.99
EYEMED VISION EYEMED VISION
BASIC EXPANDED
Employee Only Employee Only
301 302
$40.20 $70.32
0 $40.20 0 $70.32
$2.01 $3.52
EYEMED VISION EYEMED VISION
BASIC EXPANDED
Employee + Child(ren) Employee + Child(ren)
303 304
$80.28 $140.64
0 $80.28 0 $140.64
$4.01 $7.03
EYEMED VISION EYEMED VISION
BASIC EXPANDED
Employee + Spouse Employee + Spouse
305 306
$76.20 $133.68
0 $76.20 0 $133.68
$3.81 $6.68
EYEMED VISION EYEMED VISION
BASIC EXPANDED
Employee + Family Employee + Family
307 308
$117.96 $206.76
0 $117.96 0 $206.76
$5.90 $10.34
PLANS
CARRIER
PREMIUM LEVEL
PAYROLL ANNUAL CODE PREMIUM
TCS COST PER YEAR
EMPLOYEE COST PER YEAR
20 PAYMENTS PER YEAR
PARTNERSHIP HEALTH STANDARD HEALTH LIMITED HEALTH HEALTHSAVINGS/CDHP NO PARTNERSHIP PROMISE PPO
CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS
Employee Only Employee Only Employee Only Employee Only Employee Only
$7,332.00 $7,500.00 $5,592.00 $5,076.00 $7,932.00
$6,598.80 $6,750.00 $5,032.80 $4,568.40 $7,138.80
$733.20 $750.00 $559.20 $507.60 $793.20
$36.66 $37.50 $27.96 $25.38 $39.66
PARTNERSHIP HEALTH STANDARD HEALTH LIMITED HEALTH HEALTHSAVINGS/CDHP NO PARTNERSHIP PROMISE PPO
CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS
Employee + Child(ren) Employee + Child(ren) Employee + Child(ren) Employee + Child(ren) Employee + Child(ren)
$11,772.00 $12,060.00 $8,904.00 $8,064.00 $12,372.00
$8,829.00 $9,045.00 $6,678.00 $6,048.00 $9,279.00
$2,943.00 $3,015.00 $2,226.00 $2,016.00 $3,093.00
$147.15 $150.75 $111.30 $100.80 $154.65
PARTNERSHIP HEALTH STANDARD HEALTH LIMITED HEALTH HEALTHSAVINGS/CDHP NO PARTNERSHIP PROMISE PPO
CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS
Employee + Spouse Employee + Spouse Employee + Spouse Employee + Spouse Employee + Spouse
$14,316.00 $14,640.00 $10,920.00 $9,927.00 $15,516.00
$10,737.00 $10,980.00 $8,190.00 $7,445.25 $11,637.00
$3,579.00 $3,660.00 $2,730.00 $2,481.75 $3,879.00
$178.95 $183.00 $136.50 $124.09 $193.95
PARTNERSHIP HEALTH STANDARD HEALTH LIMITED HEALTH HEALTHSAVINGS/CDHP NO PARTNERSHIP PROMISE PPO
CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS
Employee + Spouse + Children Employee + Spouse + Children Employee + Spouse + Children Employee + Spouse + Children Employee + Spouse + Children
$18,756.00 $19,200.00 $14,232.00 $12,900.00 $19,956.00
$14,067.00 $14,400.00 $10,674.00 $9,675.00 $14,967.00
$4,689.00 $4,800.00 $3,558.00 $3,225.00 $4,989.00
$234.45 $240.00 $177.90 $161.25 $249.45
PARTNERSHIP HEALTH STANDARD HEALTH LIMITED HEALTH HEALTHSAVINGS/CDHP NO PARTNERSHIP PROMISE PPO
CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS CIGNA OPEN ACCESS
2 TCS Employees + Children 2 TCS Employees + Children 2 TCS Employees + Children 2 TCS Employees + Children 3 TCS Employees + Children
$18,756.00 $19,200.00 $14,232.00 $12,900.00 $19,956.00
$15,942.60 $16,320.00 $12,097.20 $10,965.00 $16,962.60
$2,813.40 $2,880.00 $2,134.80 $1,935.00 $2,993.40
$140.67 $144.00 $106.74 $96.75 $149.67
