FY2005 Health Plan Open Enrollment <br />(AFSCME-Represented Limited Duration & Benefitted Temporary Recreation Employees) <br />May 24, 2004 <br />Page 2 <br />You will be notified of any benefit changes resulting from current AFSCME contract negotiations. A <br />separate open enrollment will be scheduled if necessary. <br />Comparison of Benefits <br />The enclosed Comparison of Benefits highlights the coverage provided under the plans and is <br />designed to help you compare and evaluate the plans before you enrdll. The Comparison of Benefits <br />summarizes the general benefits under each plan and does not provide a full description of benefits. <br />If you have questions on Open Enrollment, contact Benefits Staff in HRRS at x8868 or x5924. <br />Enclosure <br />.4RSC.~IE-R ~l <br />Lirr~%tea' Draration and B~enefittod Te~-r~rary Re~o~~tion <br />Err,/oye~e Payroll Rea'ucfi~ons FYZ0105.~ <br />(Effective July 1, 2004) <br />1. For AFSCT`1E-represented Lirrtited Duration and BTR (Benefitted Temporary Rea~eation) employees opting <br />for dependent coverage. <br />2. Gist equals the difference between Two-party or Family coverage less the Individual monthly amount. <br />3. Gty Health Plan is the only option for AFSCME-represented Limited Duration and BTR employees. <br />4. Payrdl reductions are taken on a pre-tax basis, except when covering Danestic Partners. <br />:AFSCME-Ratted Employee Marthly Med/DentNis Rates: <br />Gty Health Plan <br />'Individual $422.32/ mo. <br />Two Party $780.74 /mo. <br />Farryly $1,090.63 /rrb. <br />AFSCME-Represerrbed Payroll deductions Per Pay Period: <br />Employee-only $0.00 /pay period <br />Employee plus one dependent $179.21/ pay period (twine each month) <br />Employee plus two or more dependents $334.16 /pay period (twice each month) <br />