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Part-Time Employee Health Insurance Options for PY2005 <br />May 24, 2004 <br />Page 2 <br />A FSCME- R e p r r es e n to a l <br />Regu/ar Part-Time Emp/oyee Payro/l Reductions FY2005•• <br />(Effective July 1, 2004) <br />1. For part-time employees opting for dependent coverage under City Health Plan, or <br />individual/dependent coverage under PacificSource. <br />2. Payroll reductions are taken on a pre-tax basis, except when wvering Domestic Partners. <br />', AFSCME-Renresenil~d Emplovee Morrthly Med/Derrt~s Rates: <br />City Health Plan PacificSource ' <br />''.Individual $422.32 /mo. $357.61 /mo. <br />'Two Party $780.74 /mo. $721.64 /mo. <br />Family $1,090.63 /mo. $1,053.88 /mo. <br />AFSCME-Represented Payroll deductions Per Pay Period: <br />Work schedule of 20 - 23.9 hours[week (50% of Monthly Premium): <br />City Health Plan PacificSource <br />Individual $0.00 /pay period $89.40 /pay period <br />Two Party $195.19 /pay period $180.41 /pay period <br />Family $272.66 /pay period $263.47 /pay period <br />Work sdiedule of 24 - 31.9 hours/week (25% of Monthly Premium): <br />City Health Plan PacificSource <br />Individual $0.00 /pay period $44.70 /pay period <br />Two Party $97.59 /pay period $90.21 /pay period <br />Family $136.33 /pay period $131.74 /pay period <br />Work sdiedule of 32 - 40 hours/week (Same Contrit~ution as Full-time Employees): <br />City Health Plan PacificSource <br />Individual $0.00 /pay period $0.00 /pay period <br />Two Party $0.00 /pay period $0.00 /pay period <br />Family $0.00 /pay period $0.00 /pay period <br />