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Part-Time Employee Health Insurance Options for FY2005 <br />May 24, 2004 <br />Page 2 <br />Non-Represented <br />Regular Part- Time Emp/ogee Payroll Reductions FY2005: <br />(Effective July 1, 2004) <br />1. For part-time employees opting for individual/dependent coverage under City Health Plan or PacificSource. <br />2. Payroll reductions are taken on a pre-tax basis, except when covering Domestic Partners. <br />3. Non-represented full-time employee deduction is 8% of the premium.* <br /> City Health Plan PacificSource <br />Individual $397.36 /mo. $280.68 /mo. <br />Two Party $734.29 /mo. $564.78 /mo. <br />Family $1,026.20 /mo. $825.14 /mo. <br /> <br /> *Non-represented fu//-time emp/ovee month/v deductions• <br /> City Hea/th Plan PacificSource <br />Individua/ $31.79 $22.46 <br />Two Party $58.75 $45.19 <br />Fami/y $82.10 .$'66.02 <br />Non-Represented Payroll deductions Per Pav Period: <br />Work schedule of 20 - 23.9 hours/week (50% of premium): <br />City Health Plan PacificSource <br />Individual $15.90 /pay period** $70.17 /pay period <br />Two Party $183.57 /pay period $141.20 /pay period <br />Family $256.55 /pay period $206.29 /pay period <br />Work schedule of 24 - 31.9 hours/week (25°io of premium): <br />City Health Plan PacificSource <br />Individual $15.90 /pay period** $35.09 /pay period <br />Two Party $91.79 /pay period $70.60 /pay period <br />Family $128.28 /pay period $103.14 /pay period <br />Work scheduie of 32 - 40 hours/week (Same Contribution as Full-time Employees): <br />City Health Plan PacificSource <br />Individual. $15.90 /pay period $11.23 /pay period <br />Two Party $29.38 /pay period $22.60 /pay period <br />Family $41.05 /pay period $33.01 /pay period <br />** Low cost option for employee-only coverage on City Health Plan. <br />