10/5/2017 City of MilwaukeeDepartment of Employee Relations

WEBSITE 2018 RETIREE RATE CHARTS\RC_1

1 General City, Fire or Police Retirees age 65 and over.2 Ordinary Disability Retiree3 Certain General City Retirees under age 60, or between 60-65 paying for health coverage.4 Surviving Spouses of certain General City, Fire or Police Service Retirees.

UHC Choice Plus(PPO)

UHC Choice(EPO)

$781.50 $723.00

$1,564.50 $1,444.50

$2,346.00 $2,167.50

$300.75 $351.75

$568.50 $703.50

$1,302.75 $1,127.25

$1,526.25 $1,514.25

$796.50 $1,091.25

$1,173.75 $1,083.75

$738.00 $739.50

"With Medicare" means having both parts of Medicare, Hospital (Part A) and Medical (Part B).

2 Two Adults no Medicare

2018 MONTHLY RATE CHARTFOR RETIREES & SURVIVING SPOUSES

These rates are effective January 1, 2018We will deduct the new rates effective with your December 2017 pension check.

This is official notification of health plan rates for 2018. DO NOT discard this rate chart.

RATE CHART 1 - These Rates Apply To You If You Are:

2018 Monthly Health Premium Rates - 75% of Full Premium

Plan Code

If you are or your family consists of:

1 One Adult No Medicare

3 Two Adults & Dependent Child(ren) no Medicare

4 One Adult with Medicare

5 Two Adults with Medicare

6 One Adult with Medicare, One Adult w/o Medicare

7 One Adult with Medicare, One Adult w/o Medicare & Dependent Child(ren)

8 Two Adults with Medicare & Dependent Child(ren)

9 Adult & Dependent Child(ren) no Medicare

10 Adult with Medicare & Dependent Child(ren)

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

10/5/2017 City of MilwaukeeDepartment of Employee Relations

WEBSITE 2018 RETIREE RATE CHARTS\RC_7

We will deduct the new rates effective with your December 2017 pension check.This is official notification of health plan rates for 2018. DO NOT discard this rate chart.

DO NOT discard this rate chart.

RATE CHART 7 - These Monthly Rates Apply To You If You Are:

1 Fire Service Retiree on or after 3/1/85, up to age 65.2 Police Service Retiree on or after 1/1/85, up to age 65.

2018 Monthly Health Premium Rates - 75% of Full Premium

UHC Choice Plus (PPO) UHC Choice (EPO)

City of Milwaukee

Employes' Retirement System (ERS)

789 N. Water St, Suite 300

Milwaukee, WI 53202

"With Medicare" means having both parts of Medicare, Hospital (Part A) and Medical (Part B).

1 One Adult No MedicareBecause of the compexity of the rate schedule for your Retiree Group, we are unable to produce a Rate Chart for you that would show all the rates. Each Plan Code shown at left can have 35 different rate permutations.

2018 MONTHLY RATE CHARTFOR RETIREES & SURVIVING SPOUSES

These rates are effective January 1, 2018

Plan Code

If you are or your family consists of:

2 Two Adults no MedicareWe could not possibly reproduce all those rates on this one sheet. We therefore ask that if you want to know how much your rate will be for the coming plan year, that you write to ERS at the address shown below.

3 Two Adults & Dependent Child(ren) no MedicarePlease keep in mind that we are especially busy during the Open Enrollment. Even if you call our office for your rate, we may only be able to record your name and address for follow-up in writing.

4 One Adult with Medicare

5 Two Adults with Medicare

6 One Adult with Medicare, One Adult w/o Medicare

10 Adult with Medicare & Dependent Child(ren)

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

7 One Adult with Medicare, One Adult w/o Medicare & Dependent Child(ren)

8 Two Adults with Medicare & Dependent Child(ren)

9 Adult & Dependent Child(ren) no Medicare

10/5/2017 City of MilwaukeeEmployes' Retirement System

WEBSITE 2018 RETIREE RATE CHARTS\RC_8_DDGC_Post12-31-90

These rates are effective January 1, 2018

HEALTH PLAN "EMPLOYEE RATE" INFORMATIONA Duty Disability Retiree will pay the rate listed below under "Employee Rate" for the plan selected each month

CHART 8 - 2018

HEALTH PLAN UHC CHOICE PLAN City Share

Employee Rate

UHC CHOICE PLUS PLAN City Share

Employee Rate

Single 617.00$ 542.96$ 74.04$ 726.00$ 542.96$ 183.04$

Employee + Spouse 1,234.00$ 1,085.92$ 148.08$ 1,452.00$ 1,085.92$ 366.08$

Employee + Child(ren) 926.00$ 814.88$ 111.12$ 1,089.00$ 814.88$ 274.12$

Family 1,851.00$ 1,628.88$ 222.12$ 2,178.00$ 1,628.88$ 549.12$

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

2018 MONTHLY RATE CHART FOR DUTY DISABILITY RETIREES

RATE CHART 8This Chart applies to all Duty Disability Retirees whose positions are represented by any of the following units:

GC Management; District Council #48; NMNR; TEAM; Assc of Scientific Pers; Assc of Muni Attys; SNC; Loc 510 IAM; Loc 494 Mach; Loc 75 Plumbers; Loc 195 Bridge Operators; Loc 139; Loc 61 Sanitation; ALEASP; Police Aides; Loc 494 FEDS; LOC

494, MBCTC

The "Employee Rate" will be deducted from the Retiree's monthly pension.

UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)

10/5/2017 City of MilwaukeeEmployes' Retirement System

WEBSITE 2018 RETIREE RATE CHARTS\RC_13_DD MPA

These rates are effective January 1, 2018

CHART 13 - 2018

HEALTH PLAN UHC CHOICE PLAN City Share

Employee Rate

UHC CHOICE PLUS PLAN City Share

Employee Rate

Single 617.00$ 542.96$ 74.04$ 726.00$ 638.88$ 87.12$

Employee + Spouse 1,234.00$ 1,085.92$ 148.08$ 1,452.00$ 1,277.76$ 174.24$

Employee + Child(ren) 926.00$ 814.88$ 111.12$ 1,089.00$ 958.32$ 130.68$

Family 1,851.00$ 1,628.88$ 222.12$ 2,178.00$ 1,916.64$ 261.36$

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

2018 MONTHLY RATE CHART FOR DUTY DISABILITY RETIREES

RATE CHART 13

This Chart applies to all duty disability retirees whose positions are represented by any of the following units:

Milwaukee Police Association (MPA); Sworn Police Mgmt; Milwaukee Police Supervisors Organization (MPSO); Sworn Fire Mgmt; Milwaukee Professional Firefighters Assc, Loc 215;

The "Employee Rate" will be deducted from the Retiree's monthly pension.

UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)

10/5/2017 City of MilwaukeeDepartment of Employee Relations

WEBSITE 2018 RETIREE RATE CHARTS\RC_16_MGT>0104<0109

These rates are effective January 1, 2018

COMPUTATION METHOD OF "CITY SHARE"

CHART 16 - 2018

HEALTH PLAN UHC CHOICE PLAN City Share

Retiree Rate

UHC CHOICE PLUS PLAN City Share

Retiree Rate

Single 964.00$ 964.00$ -$ 1,042.00$ 964.00$ 78.00$

Employee + Spouse 1,926.00$ 1,926.00$ -$ 2,086.00$ 1,926.00$ 160.00$

Employee + Child(ren) 1,445.00$ 1,445.00$ -$ 1,565.00$ 1,445.00$ 120.00$

Family 2,890.00$ 2,890.00$ -$ 3,128.00$ 2,890.00$ 238.00$

UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

2018 MONTHLY RATE CHART FOR RETIREES & SURVIVING SPOUSES

RATE CHART 16This Chart applies to all Normal Service Retirees under 65 whose positions are represented by any of the following units and retired on or after

1/1/04 and prior to 1/1/09:

General City Management

The CITY will pay, monthly, 100% of the lowest cost single or lowest cost family plan. This is official notification of health plan rates for 2018. DO NOT discard this rate chart.

The "Retiree Rate" will be deducted from the Retiree's monthly pension.

10/5/2017 City of MilwaukeeDepartment of Employee Relations

WEBSITE 2018 RETIREE RATE CHARTS\RC_17_GC>010105

These rates are effective January 1, 2018

*For Loc 494 Elec on or after 1/1/05 and prior to May 31, 2012;*For MBCTC on or after 1/1/05 and prior to July 31, 2012.

CHART 17 - 2018The "Retiree Rate" will be deducted from the Retiree's monthly pension.

HEALTH PLAN UHC CHOICE PLAN City Share

Retiree Rate

UHC CHOICE PLUS PLAN City Share

Retiree Rate

Single 964.00$ 964.00$ NO COST 1,042.00$ 1,012.00$ 30.00$

Employee + Spouse 1,926.00$ 1,926.00$ NO COST 2,086.00$ 2,026.00$ 60.00$

Employee + Child(ren) 1,445.00$ 1,445.00$ NO COST 1,565.00$ 1,505.00$ 60.00$

Family 2,890.00$ 2,890.00$ NO COST 3,128.00$ 3,068.00$ 60.00$

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

2018 MONTHLY RATE CHART FOR GENERAL CITY RETIREES

RATE CHART 17This Chart applies to all Retirees whose positions are represented by any of the following units:

For General City Retirees under 65 retired on or after 1/1/05 and prior to 1/1/12:

District Council 48; Loc 139; Loc 75 Plumbers; Loc 61 Sanitation; SNC; TEAM; Assc of Scient Pers; Assc of Muni Attys; Loc 494 Mach Shop; Loc 510 IAM Dist 10; ALEASP (Clerical & PSS); NMNR; Fire Equip Dispatchers;

UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)

10/5/2017 City of MilwaukeeDepartment of Employee Relations

WEBSITE 2018 RETIREE RATE CHARTS\RC_18_GC<0105

2018 MONTHLY RATE CHART FOR GENERAL CITY RETIREESThese rates are effective January 1, 2018

A General City Retirees retired prior to 1/1/05A Management retiree retired prior to 1/1/04

A General City or Manangement Duty Disability retiree prior to 1/1/91Sworn Police Management, MPA & MPSO Duty Disability retired prior to 1/1/90

Sworn Fire Management Duty Disability retired prior to 3/1/89Local 215 Duty Disability retired prior to 1/1/90

COMPUTATION METHOD OF "RETIREE SHARE"

CHART 18 - 2018The "Retiree Rate" will be deducted from the Retiree's monthly pension.

HEALTH PLAN UHC CHOICE PLAN City Share

Retiree Rate

UHC CHOICE PLUS PLAN City Share Retiree Rate

Single 964.00$ 964.00$ NO COST 1,042.00$ 1,042.00$ NO COST

Employee + Spouse 1,926.00$ 1,926.00$ NO COST 2,086.00$ 2,086.00$ NO COST

Employee + Child(ren) 1,445.00$ 1,445.00$ NO COST 1,565.00$ 1,565.00$ NO COST

Family 2,890.00$ 2,890.00$ NO COST 3,128.00$ 3,128.00$ NO COST

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

RATE CHART 18This Chart applies to all Retirees under 65 whose positions are represented by any of the following units:

The CITY will pay, monthly, up to 100% of the UHC Choice Plus (PPO) (Basic Plan) single or UHC Choice Plus (PPO) (Basic Plan) family premium cost to the City. For 2018, this contribution ("Retiree Rate") will be no more than $1,042 (Single) or $3,128 (Family) toward the cost of Health Plan of your choice. We will deduct the new rates effective with your December 2017 pension check. This is official notification of health plan rates for 2018. DO NOT discard this rate chart.

UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)

10/5/2017 City of MilwaukeeEmployes' Retirement System

WEBSITE 2018 RETIREE RATE CHARTS/RC_20_MGM>0110

These rates are effective January 1, 2018

The "Retiree Rate" will be deducted from the Retiree's monthly pension.

CHART 20 - 2018

HEALTH PLAN UHC CHOICE PLAN City Share

Retiree Rate

UHC CHOICE PLUS PLAN City Share

Retiree Rate

Single 964.00$ 848.32$ 115.68$ 1,042.00$ 916.96$ 125.04$

Employee + Spouse 1,926.00$ 1,694.88$ 231.12$ 2,086.00$ 1,835.68$ 250.32$

Employee + Child(ren) 1,445.00$ 1,271.60$ 173.40$ 1,565.00$ 1,377.20$ 187.80$

Family 2,890.00$ 2,543.20$ 346.80$ 3,128.00$ 2,752.64$ 375.36$

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

2018 MONTHLY RATE CHART FOR RETIREES & SURVIVING SPOUSES

RATE CHART 20

This Chart applies to all Normal Service Retirees under 65 whose positions are represented by any of the following units and retired on or after 1/1/12 through 12/31/2013:

District Council #48; NMNR; TEAM;Assc of Scientific Pers; Assc of Muni Attys; SNC: Loc 510 IAM; Loc 494 Mach; Loc 75 Plumbers;

Loc 195 Bridge Operators; Loc 139; Loc 61 Sanitation; ALEASP; Police Aides; Loc 494 FEDS

GC Management on or after January 1, 2009 through 12/31/2013;For Loc 494 Elec, on or after May 31, 2012 through 12/31/2013;

For MBCTC, on or after July 31, 2012 through 12/31/2013.

UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)

10/5/2017 City of MilwaukeeEmployes' Retirement System

WEBSITE 2018 RETIREE RATE CHARTS/RC_21_GC>0114

These rates are effective January 1, 2018

District Council #48; NMNR; TEAM;Assc of Scientific Pers; Assc of Muni Attys; SNC: Loc 510 IAM; Loc 494 Mach; Loc 75 Plumbers; 195 Bridge Operators;

Loc 139; Loc 61 Sanitation; ALEASP; Police Aides; Loc 494 FEDS; GC Management; Loc 494 Elec; MBCTS

The "Retiree Rate" will be deducted from the Retiree's monthly pension.

CHART 21 - 2018

HEALTH PLAN UHC CHOICE PLAN City Share

Retiree Rate

UHC CHOICE PLUS PLAN City Share

Retiree Rate

Single 964.00$ 848.32$ 115.68$ 1,042.00$ 848.32$ 193.68$

Employee + Spouse 1,926.00$ 1,694.88$ 231.12$ 2,086.00$ 1,694.88$ 391.12$

Employee + Child(ren) 1,445.00$ 1,271.60$ 173.40$ 1,565.00$ 1,271.60$ 293.40$

Family 2,890.00$ 2,543.20$ 346.80$ 3,128.00$ 2,543.20$ 584.80$

ACA NOTICE: If a retiree waives their health insurance and if the retiree does not have other health insurance benefits or coverage through a spouse or family member, the retiree will be subject to the Affordable Care Act and any financial penalties associated with not having health insurance benefits. 

2018 MONTHLY RATE CHART FOR RETIREES & SURVIVING SPOUSES

RATE CHART 21This Chart applies to all Normal Service Retirees under 65 whose positions are represented by any of the following units and retired on or after 1/1/14:

UHC CHOICE PLAN (EPO) UHC CHOICE PLUS PLAN (PPO)

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 10 of 51

100% RETIREE PLAN RATES

PC Description UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 1,042.00$ 964.00$ 2 Two Adults w/o Medicare 2,086.00$ 1,926.00$ 3 Two Adults & Dependent Child(ren) 3,128.00$ 2,890.00$ 4 One Adult with Medicare 401.00$ 469.00$ 5 Two Adults with Medicare 758.00$ 938.00$ 6 One Adult with Medicare, One person w/o Medicare 1,737.00$ 1,503.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 2,035.00$ 2,019.00$ 8 Two Adults with Medicare & Dependent Child(ren) 1,062.00$ 1,455.00$ 9 Adult & Dependent Child(ren) 1,565.00$ 1,445.00$

10 Adult with Medicare & Dependent Child(ren) 984.00$ 986.00$ @ 65% City Contribution - POLICE (40hrs/wk) - Unused S/L - Less than 150 work days

PC @65% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 364.70 286.70 2 Two Adults w/o Medicare 730.10 570.10 3 Two Adults & Dependent Child(ren) 1,094.80 856.80 4 One Adult with Medicare 140.35 208.35 5 Two Adults with Medicare 265.30 445.30 6 One Adult with Medicare, One person w/o Medicare 607.95 373.95 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 712.25 696.25 8 Two Adults with Medicare & Dependent Child(ren) 371.70 764.70 9 Adult & Dependent Child(ren) 547.75 427.75

10 Adult with Medicare & Dependent Child(ren) 344.40 346.40 @ 66% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 150 but less than 159 work days.

PC @66% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 354.28 276.28 2 Two Adults w/o Medicare 709.24 549.24 3 Two Adults & Dependent Child(ren) 1,063.52 825.52 4 One Adult with Medicare 136.34 204.34 5 Two Adults with Medicare 257.72 437.72 6 One Adult with Medicare, One person w/o Medicare 590.58 356.58 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 691.90 675.90 8 Two Adults with Medicare & Dependent Child(ren) 361.08 754.08 9 Adult & Dependent Child(ren) 532.10 412.10

10 Adult with Medicare & Dependent Child(ren) 334.56 336.56 @ 67% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 159 but less than 167 work days.

PC @67% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 343.86 265.86 2 Two Adults w/o Medicare 688.38 528.38 3 Two Adults & Dependent Child(ren) 1,032.24 794.24 4 One Adult with Medicare 132.33 200.33 5 Two Adults with Medicare 250.14 430.14 6 One Adult with Medicare, One person w/o Medicare 573.21 339.21 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 671.55 655.55 8 Two Adults with Medicare & Dependent Child(ren) 350.46 743.46 9 Adult & Dependent Child(ren) 516.45 396.45

10 Adult with Medicare & Dependent Child(ren) 324.72 326.72

POLICE RATE CHART 7 - FULL 2018 RATE

UHC CHOICE PLUS (PPO)UHC CHOICE (EPO)

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 11 of 51

@ 68% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 167 but less than 176 work days.

PC @68% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 333.44 255.44 2 Two Adults w/o Medicare 667.52 507.52 3 Two Adults & Dependent Child(ren) 1,000.96 762.96 4 One Adult with Medicare 128.32 196.32 5 Two Adults with Medicare 242.56 422.56 6 One Adult with Medicare, One person w/o Medicare 555.84 321.84 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 651.20 635.20 8 Two Adults with Medicare & Dependent Child(ren) 339.84 732.84 9 Adult & Dependent Child(ren) 500.80 380.80

10 Adult with Medicare & Dependent Child(ren) 314.88 316.88 @ 69% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 176 but less than 184 work days.

PC @69% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 323.02 245.02 2 Two Adults w/o Medicare 646.66 486.66 3 Two Adults & Dependent Child(ren) 969.68 731.68 4 One Adult with Medicare 124.31 192.31 5 Two Adults with Medicare 234.98 414.98 6 One Adult with Medicare, One person w/o Medicare 538.47 304.47 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 630.85 614.85 8 Two Adults with Medicare & Dependent Child(ren) 329.22 722.22 9 Adult & Dependent Child(ren) 485.15 365.15

10 Adult with Medicare & Dependent Child(ren) 305.04 307.04 @ 70% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 184 but less than 193 work days.

PC @70% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 312.60 234.60 2 Two Adults w/o Medicare 625.80 465.80 3 Two Adults & Dependent Child(ren) 938.40 700.40 4 One Adult with Medicare 120.30 188.30 5 Two Adults with Medicare 227.40 407.40 6 One Adult with Medicare, One person w/o Medicare 521.10 287.10 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 610.50 594.50 8 Two Adults with Medicare & Dependent Child(ren) 318.60 711.60 9 Adult & Dependent Child(ren) 469.50 349.50

10 Adult with Medicare & Dependent Child(ren) 295.20 297.20 @ 71% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 193 but less than 201 work days.

PC @71% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 302.18 224.18 2 Two Adults w/o Medicare 604.94 444.94 3 Two Adults & Dependent Child(ren) 907.12 669.12 4 One Adult with Medicare 116.29 184.29 5 Two Adults with Medicare 219.82 399.82 6 One Adult with Medicare, One person w/o Medicare 503.73 269.73 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 590.15 574.15 8 Two Adults with Medicare & Dependent Child(ren) 307.98 700.98 9 Adult & Dependent Child(ren) 453.85 333.85

10 Adult with Medicare & Dependent Child(ren) 285.36 287.36

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 12 of 51

@ 72% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 201 but less than 210 work days.

PC @72% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 291.76 213.76 2 Two Adults w/o Medicare 584.08 424.08 3 Two Adults & Dependent Child(ren) 875.84 637.84 4 One Adult with Medicare 112.28 180.28 5 Two Adults with Medicare 212.24 392.24 6 One Adult with Medicare, One person w/o Medicare 486.36 252.36 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 569.80 553.80 8 Two Adults with Medicare & Dependent Child(ren) 297.36 690.36 9 Adult & Dependent Child(ren) 438.20 318.20

10 Adult with Medicare & Dependent Child(ren) 275.52 277.52 @ 73% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 210 but less than 219 work days.

PC @73% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 281.34 203.34 2 Two Adults w/o Medicare 563.22 403.22 3 Two Adults & Dependent Child(ren) 844.56 606.56 4 One Adult with Medicare 108.27 176.27 5 Two Adults with Medicare 204.66 384.66 6 One Adult with Medicare, One person w/o Medicare 468.99 234.99 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 549.45 533.45 8 Two Adults with Medicare & Dependent Child(ren) 286.74 679.74 9 Adult & Dependent Child(ren) 422.55 302.55

10 Adult with Medicare & Dependent Child(ren) 265.68 267.68 @ 74% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 219 but less than 227 work days.

PC @74% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 270.92 192.92 2 Two Adults w/o Medicare 542.36 382.36 3 Two Adults & Dependent Child(ren) 813.28 575.28 4 One Adult with Medicare 104.26 172.26 5 Two Adults with Medicare 197.08 377.08 6 One Adult with Medicare, One person w/o Medicare 451.62 217.62 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 529.10 513.10 8 Two Adults with Medicare & Dependent Child(ren) 276.12 669.12 9 Adult & Dependent Child(ren) 406.90 286.90

10 Adult with Medicare & Dependent Child(ren) 255.84 257.84 @ 75% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 227 but less than 236 work days.

PC @75% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 260.50 182.50 2 Two Adults w/o Medicare 521.50 361.50 3 Two Adults & Dependent Child(ren) 782.00 544.00 4 One Adult with Medicare 100.25 168.25 5 Two Adults with Medicare 189.50 369.50 6 One Adult with Medicare, One person w/o Medicare 434.25 200.25 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 508.75 492.75 8 Two Adults with Medicare & Dependent Child(ren) 265.50 658.50 9 Adult & Dependent Child(ren) 391.25 271.25

10 Adult with Medicare & Dependent Child(ren) 246.00 248.00

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 13 of 51

@ 76% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 236 but less than 244 work days.

PC @76% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 250.08 172.08 2 Two Adults w/o Medicare 500.64 340.64 3 Two Adults & Dependent Child(ren) 750.72 512.72 4 One Adult with Medicare 96.24 164.24 5 Two Adults with Medicare 181.92 361.92 6 One Adult with Medicare, One person w/o Medicare 416.88 182.88 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 488.40 472.40 8 Two Adults with Medicare & Dependent Child(ren) 254.88 647.88 9 Adult & Dependent Child(ren) 375.60 255.60

10 Adult with Medicare & Dependent Child(ren) 236.16 238.16 @ 77% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 244 but less than 253 work days.

PC @77% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 239.66 161.66 2 Two Adults w/o Medicare 479.78 319.78 3 Two Adults & Dependent Child(ren) 719.44 481.44 4 One Adult with Medicare 92.23 160.23 5 Two Adults with Medicare 174.34 354.34 6 One Adult with Medicare, One person w/o Medicare 399.51 165.51 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 468.05 452.05 8 Two Adults with Medicare & Dependent Child(ren) 244.26 637.26 9 Adult & Dependent Child(ren) 359.95 239.95

10 Adult with Medicare & Dependent Child(ren) 226.32 228.32 @ 78% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 253 but less than 261 work days.

PC @78% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 229.24 151.24 2 Two Adults w/o Medicare 458.92 298.92 3 Two Adults & Dependent Child(ren) 688.16 450.16 4 One Adult with Medicare 88.22 156.22 5 Two Adults with Medicare 166.76 346.76 6 One Adult with Medicare, One person w/o Medicare 382.14 148.14 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 447.70 431.70 8 Two Adults with Medicare & Dependent Child(ren) 233.64 626.64 9 Adult & Dependent Child(ren) 344.30 224.30

10 Adult with Medicare & Dependent Child(ren) 216.48 218.48 @ 79% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 261 but less than 270 work days.

PC @79% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 218.82 140.82 2 Two Adults w/o Medicare 438.06 278.06 3 Two Adults & Dependent Child(ren) 656.88 418.88 4 One Adult with Medicare 84.21 152.21 5 Two Adults with Medicare 159.18 339.18 6 One Adult with Medicare, One person w/o Medicare 364.77 130.77 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 427.35 411.35 8 Two Adults with Medicare & Dependent Child(ren) 223.02 616.02 9 Adult & Dependent Child(ren) 328.65 208.65

10 Adult with Medicare & Dependent Child(ren) 206.64 208.64

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 14 of 51

@ 80% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 270 but less than 278 work days.

PC @80% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 208.40 130.40 2 Two Adults w/o Medicare 417.20 257.20 3 Two Adults & Dependent Child(ren) 625.60 387.60 4 One Adult with Medicare 80.20 148.20 5 Two Adults with Medicare 151.60 331.60 6 One Adult with Medicare, One person w/o Medicare 347.40 113.40 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 407.00 391.00 8 Two Adults with Medicare & Dependent Child(ren) 212.40 605.40 9 Adult & Dependent Child(ren) 313.00 193.00

10 Adult with Medicare & Dependent Child(ren) 196.80 198.80 @ 81% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 278 but less than 285 work days.

PC @81% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 197.98 119.98 2 Two Adults w/o Medicare 396.34 236.34 3 Two Adults & Dependent Child(ren) 594.32 356.32 4 One Adult with Medicare 76.19 144.19 5 Two Adults with Medicare 144.02 324.02 6 One Adult with Medicare, One person w/o Medicare 330.03 96.03 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 386.65 370.65 8 Two Adults with Medicare & Dependent Child(ren) 201.78 594.78 9 Adult & Dependent Child(ren) 297.35 177.35

10 Adult with Medicare & Dependent Child(ren) 186.96 188.96 @ 82% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 285 but less than 291 work days.

PC @82% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 187.56 109.56 2 Two Adults w/o Medicare 375.48 215.48 3 Two Adults & Dependent Child(ren) 563.04 325.04 4 One Adult with Medicare 72.18 140.18 5 Two Adults with Medicare 136.44 316.44 6 One Adult with Medicare, One person w/o Medicare 312.66 78.66 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 366.30 350.30 8 Two Adults with Medicare & Dependent Child(ren) 191.16 584.16 9 Adult & Dependent Child(ren) 281.70 161.70

10 Adult with Medicare & Dependent Child(ren) 177.12 179.12 @ 83% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 291 but less than 298 work days.

PC @83% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 177.14 99.14 2 Two Adults w/o Medicare 354.62 194.62 3 Two Adults & Dependent Child(ren) 531.76 293.76 4 One Adult with Medicare 68.17 136.17 5 Two Adults with Medicare 128.86 308.86 6 One Adult with Medicare, One person w/o Medicare 295.29 61.29 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 345.95 329.95 8 Two Adults with Medicare & Dependent Child(ren) 180.54 573.54 9 Adult & Dependent Child(ren) 266.05 146.05

10 Adult with Medicare & Dependent Child(ren) 167.28 169.28

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 15 of 51

@ 84% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 298 but less than 304 work days.

PC @84% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 166.72 88.72 2 Two Adults w/o Medicare 333.76 173.76 3 Two Adults & Dependent Child(ren) 500.48 262.48 4 One Adult with Medicare 64.16 132.16 5 Two Adults with Medicare 121.28 301.28 6 One Adult with Medicare, One person w/o Medicare 277.92 43.92 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 325.60 309.60 8 Two Adults with Medicare & Dependent Child(ren) 169.92 562.92 9 Adult & Dependent Child(ren) 250.40 130.40

10 Adult with Medicare & Dependent Child(ren) 157.44 159.44 @ 85% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 304 but less than 311 work days.

PC @85% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 156.30 78.30 2 Two Adults w/o Medicare 312.90 152.90 3 Two Adults & Dependent Child(ren) 469.20 231.20 4 One Adult with Medicare 60.15 128.15 5 Two Adults with Medicare 113.70 293.70 6 One Adult with Medicare, One person w/o Medicare 260.55 26.55 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 305.25 289.25 8 Two Adults with Medicare & Dependent Child(ren) 159.30 552.30 9 Adult & Dependent Child(ren) 234.75 114.75

10 Adult with Medicare & Dependent Child(ren) 147.60 149.60 @ 86% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 311 but less than 317 work days.

PC @86% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 145.88 67.88 2 Two Adults w/o Medicare 292.04 132.04 3 Two Adults & Dependent Child(ren) 437.92 199.92 4 One Adult with Medicare 56.14 124.14 5 Two Adults with Medicare 106.12 286.12 6 One Adult with Medicare, One person w/o Medicare 243.18 9.18 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 284.90 268.90 8 Two Adults with Medicare & Dependent Child(ren) 148.68 541.68 9 Adult & Dependent Child(ren) 219.10 99.10

10 Adult with Medicare & Dependent Child(ren) 137.76 139.76 @ 87% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 317 but less than 324 work days.

PC @87% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 135.46 57.46 2 Two Adults w/o Medicare 271.18 111.18 3 Two Adults & Dependent Child(ren) 406.64 168.64 4 One Adult with Medicare 52.13 120.13 5 Two Adults with Medicare 98.54 278.54 6 One Adult with Medicare, One person w/o Medicare 225.81 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 264.55 248.55 8 Two Adults with Medicare & Dependent Child(ren) 138.06 531.06 9 Adult & Dependent Child(ren) 203.45 83.45

10 Adult with Medicare & Dependent Child(ren) 127.92 129.92

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 16 of 51

@ 88% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 324 but less than 330 work days.

PC @88% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 125.04 47.04 2 Two Adults w/o Medicare 250.32 90.32 3 Two Adults & Dependent Child(ren) 375.36 137.36 4 One Adult with Medicare 48.12 116.12 5 Two Adults with Medicare 90.96 270.96 6 One Adult with Medicare, One person w/o Medicare 208.44 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 244.20 228.20 8 Two Adults with Medicare & Dependent Child(ren) 127.44 520.44 9 Adult & Dependent Child(ren) 187.80 67.80

10 Adult with Medicare & Dependent Child(ren) 118.08 120.08 @ 89% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 330 but less than 336 work days.

PC @89% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 114.62 36.62 2 Two Adults w/o Medicare 229.46 69.46 3 Two Adults & Dependent Child(ren) 344.08 106.08 4 One Adult with Medicare 44.11 112.11 5 Two Adults with Medicare 83.38 263.38 6 One Adult with Medicare, One person w/o Medicare 191.07 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 223.85 207.85 8 Two Adults with Medicare & Dependent Child(ren) 116.82 509.82 9 Adult & Dependent Child(ren) 172.15 52.15

10 Adult with Medicare & Dependent Child(ren) 108.24 110.24 @ 90% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 336 but less than 343 work days.

PC @90% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 104.20 26.20 2 Two Adults w/o Medicare 208.60 48.60 3 Two Adults & Dependent Child(ren) 312.80 74.80 4 One Adult with Medicare 40.10 108.10 5 Two Adults with Medicare 75.80 255.80 6 One Adult with Medicare, One person w/o Medicare 173.70 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 203.50 187.50 8 Two Adults with Medicare & Dependent Child(ren) 106.20 499.20 9 Adult & Dependent Child(ren) 156.50 36.50

10 Adult with Medicare & Dependent Child(ren) 98.40 100.40 @ 91% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 343 but less than 349 work days.

PC @91% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 93.78 15.78 2 Two Adults w/o Medicare 187.74 27.74 3 Two Adults & Dependent Child(ren) 281.52 43.52 4 One Adult with Medicare 36.09 104.09 5 Two Adults with Medicare 68.22 248.22 6 One Adult with Medicare, One person w/o Medicare 156.33 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 183.15 167.15 8 Two Adults with Medicare & Dependent Child(ren) 95.58 488.58 9 Adult & Dependent Child(ren) 140.85 20.85

10 Adult with Medicare & Dependent Child(ren) 88.56 90.56

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 17 of 51

@ 92% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 349 but less than 356 work days.

PC @92% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 83.36 5.36 2 Two Adults w/o Medicare 166.88 6.88 3 Two Adults & Dependent Child(ren) 250.24 12.24 4 One Adult with Medicare 32.08 100.08 5 Two Adults with Medicare 60.64 240.64 6 One Adult with Medicare, One person w/o Medicare 138.96 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 162.80 146.80 8 Two Adults with Medicare & Dependent Child(ren) 84.96 477.96 9 Adult & Dependent Child(ren) 125.20 5.20

10 Adult with Medicare & Dependent Child(ren) 78.72 80.72 @ 93% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 356 but less than 362 work days.

PC @93% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 72.94 - 2 Two Adults w/o Medicare 146.02 - 3 Two Adults & Dependent Child(ren) 218.96 - 4 One Adult with Medicare 28.07 96.07 5 Two Adults with Medicare 53.06 233.06 6 One Adult with Medicare, One person w/o Medicare 121.59 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 142.45 126.45 8 Two Adults with Medicare & Dependent Child(ren) 74.34 467.34 9 Adult & Dependent Child(ren) 109.55 -

10 Adult with Medicare & Dependent Child(ren) 68.88 70.88 @ 94% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 362 but less than 369 work days.

PC @94% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 62.52 - 2 Two Adults w/o Medicare 125.16 - 3 Two Adults & Dependent Child(ren) 187.68 - 4 One Adult with Medicare 24.06 92.06 5 Two Adults with Medicare 45.48 225.48 6 One Adult with Medicare, One person w/o Medicare 104.22 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 122.10 106.10 8 Two Adults with Medicare & Dependent Child(ren) 63.72 456.72 9 Adult & Dependent Child(ren) 93.90 -

10 Adult with Medicare & Dependent Child(ren) 59.04 61.04 @ 95% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 369 but less than 375 work days.

PC @95% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 52.10 - 2 Two Adults w/o Medicare 104.30 - 3 Two Adults & Dependent Child(ren) 156.40 - 4 One Adult with Medicare 20.05 88.05 5 Two Adults with Medicare 37.90 217.90 6 One Adult with Medicare, One person w/o Medicare 86.85 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 101.75 85.75 8 Two Adults with Medicare & Dependent Child(ren) 53.10 446.10 9 Adult & Dependent Child(ren) 78.25 -

10 Adult with Medicare & Dependent Child(ren) 49.20 51.20

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 18 of 51

@ 96% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 375 but less than 381 work days.

PC @96% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 41.68 - 2 Two Adults w/o Medicare 83.44 - 3 Two Adults & Dependent Child(ren) 125.12 - 4 One Adult with Medicare 16.04 84.04 5 Two Adults with Medicare 30.32 210.32 6 One Adult with Medicare, One person w/o Medicare 69.48 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 81.40 65.40 8 Two Adults with Medicare & Dependent Child(ren) 42.48 435.48 9 Adult & Dependent Child(ren) 62.60 -

10 Adult with Medicare & Dependent Child(ren) 39.36 41.36 @ 97% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 381 but less than 388 work days.

PC @97% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 31.26 - 2 Two Adults w/o Medicare 62.58 - 3 Two Adults & Dependent Child(ren) 93.84 - 4 One Adult with Medicare 12.03 80.03 5 Two Adults with Medicare 22.74 202.74 6 One Adult with Medicare, One person w/o Medicare 52.11 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 61.05 45.05 8 Two Adults with Medicare & Dependent Child(ren) 31.86 424.86 9 Adult & Dependent Child(ren) 46.95 -

10 Adult with Medicare & Dependent Child(ren) 29.52 31.52 @ 98% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 388 but less than 394 work days.

PC @98% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 20.84 - 2 Two Adults w/o Medicare 41.72 - 3 Two Adults & Dependent Child(ren) 62.56 - 4 One Adult with Medicare 8.02 76.02 5 Two Adults with Medicare 15.16 195.16 6 One Adult with Medicare, One person w/o Medicare 34.74 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 40.70 24.70 8 Two Adults with Medicare & Dependent Child(ren) 21.24 414.24 9 Adult & Dependent Child(ren) 31.30 -

10 Adult with Medicare & Dependent Child(ren) 19.68 21.68 @ 99% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 394 but less than 400 work days.

PC @99% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 10.42 - 2 Two Adults w/o Medicare 20.86 - 3 Two Adults & Dependent Child(ren) 31.28 - 4 One Adult with Medicare 4.01 72.01 5 Two Adults with Medicare 7.58 187.58 6 One Adult with Medicare, One person w/o Medicare 17.37 - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 20.35 4.35 8 Two Adults with Medicare & Dependent Child(ren) 10.62 403.62 9 Adult & Dependent Child(ren) 15.65 -

10 Adult with Medicare & Dependent Child(ren) 9.84 11.84

10/5/2017 2017 Police thru Age 60 (40hrs/wk) Contribution Rate Matrix

WEBSITE 2018 RETIREE RATE CHARTS\Police thru age 60 40HRWK 19 of 51

@ 100% City Contribution - POLICE (40hrs/wk) - Unused S/L - At least 400 work days.

PC @100% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare - - 2 Two Adults w/o Medicare - - 3 Two Adults & Dependent Child(ren) - - 4 One Adult with Medicare - 68.00 5 Two Adults with Medicare - 180.00 6 One Adult with Medicare, One person w/o Medicare - - 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) - - 8 Two Adults with Medicare & Dependent Child(ren) - 393.00 9 Adult & Dependent Child(ren) - -

10 Adult with Medicare & Dependent Child(ren) - 2.00

10/5/2017 2017 HEALTH PLAN RATES FOR POLICE AGE 60-64 (Less than 65) Rev: 9/??/2016

20 of 51 WEBSITE 2018 RETIREE RATE CHARTS\POL 6064

A B C D E F G I J K L M N OUHC CHOICE

PLUSUHC CHOICE

PLUSUHC CHOICE

PLUSUHC CHOICE

PLUS UHC CHOICEUHC CHOICE

PLUSUHC CHOICE

PLUSUHC CHOICE

PLUSUHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 65% > of Retiree Retiree Plan 100% 100% 66% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 677.30 1,042.00 0.00 0.00 1 1,042.00 1,042.00 687.72 1,042.00 0.00 0.002 2,086.00 1,042.00 1,355.90 1,355.90 730.10 570.10 2 2,086.00 1,042.00 1,376.76 1,376.76 709.24 549.243 3,128.00 1,042.00 2,033.20 2,033.20 1,094.80 856.80 3 3,128.00 1,042.00 2,064.48 2,064.48 1,063.52 825.524 401.00 1,042.00 260.65 1,042.00 0.00 0.00 4 401.00 1,042.00 264.66 1,042.00 0.00 0.005 758.00 1,042.00 492.70 1,042.00 0.00 0.00 5 758.00 1,042.00 500.28 1,042.00 0.00 0.006 1,737.00 1,042.00 1,129.05 1,129.05 607.95 373.95 6 1,737.00 1,042.00 1,146.42 1,146.42 590.58 356.587 2,035.00 1,042.00 1,322.75 1,322.75 712.25 696.25 7 2,035.00 1,042.00 1,343.10 1,343.10 691.90 675.908 1,062.00 1,042.00 690.30 1,042.00 20.00 413.00 8 1,062.00 1,042.00 700.92 1,042.00 20.00 413.009 1,565.00 1,042.00 1,017.25 1,042.00 523.00 403.00 9 1,565.00 1,042.00 1,032.90 1,042.00 523.00 403.0010 984.00 1,042.00 639.60 1,042.00 0.00 0.00 10 984.00 1,042.00 649.44 1,042.00 0.00 0.00

UHC CHOICE PLUS

UHC CHOICE PLUS

UHC CHOICE PLUS

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUSUHC CHOICE

PLUSUHC CHOICE

PLUSUHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 67% > of Retiree Retiree Plan 100% 100% 68% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 698.14 1,042.00 0.00 0.00 1 1,042.00 1,042.00 708.56 1,042.00 0.00 0.002 2,086.00 1,042.00 1,397.62 1,397.62 688.38 528.38 2 2,086.00 1,042.00 1,418.48 1,418.48 667.52 507.523 3,128.00 1,042.00 2,095.76 2,095.76 1,032.24 794.24 3 3,128.00 1,042.00 2,127.04 2,127.04 1,000.96 762.964 401.00 1,042.00 268.67 1,042.00 0.00 0.00 4 401.00 1,042.00 272.68 1,042.00 0.00 0.005 758.00 1,042.00 507.86 1,042.00 0.00 0.00 5 758.00 1,042.00 515.44 1,042.00 0.00 0.006 1,737.00 1,042.00 1,163.79 1,163.79 573.21 339.21 6 1,737.00 1,042.00 1,181.16 1,181.16 555.84 321.847 2,035.00 1,042.00 1,363.45 1,363.45 671.55 655.55 7 2,035.00 1,042.00 1,383.80 1,383.80 651.20 635.208 1,062.00 1,042.00 711.54 1,042.00 20.00 413.00 8 1,062.00 1,042.00 722.16 1,042.00 20.00 413.009 1,565.00 1,042.00 1,048.55 1,048.55 516.45 396.45 9 1,565.00 1,042.00 1,064.20 1,064.20 500.80 380.8010 984.00 1,042.00 659.28 1,042.00 0.00 0.00 10 984.00 1,042.00 669.12 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 69% > of Retiree Retiree Plan 100% 100% 70% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 718.98 1,042.00 0.00 0.00 1 1,042.00 1,042.00 729.40 1,042.00 0.00 0.002 2,086.00 1,042.00 1,439.34 1,439.34 646.66 486.66 2 2,086.00 1,042.00 1,460.20 1,460.20 625.80 465.803 3,128.00 1,042.00 2,158.32 2,158.32 969.68 731.68 3 3,128.00 1,042.00 2,189.60 2,189.60 938.40 700.404 401.00 1,042.00 276.69 1,042.00 0.00 0.00 4 401.00 1,042.00 280.70 1,042.00 0.00 0.005 758.00 1,042.00 523.02 1,042.00 0.00 0.00 5 758.00 1,042.00 530.60 1,042.00 0.00 0.006 1,737.00 1,042.00 1,198.53 1,198.53 538.47 304.47 6 1,737.00 1,042.00 1,215.90 1,215.90 521.10 287.107 2,035.00 1,042.00 1,404.15 1,404.15 630.85 614.85 7 2,035.00 1,042.00 1,424.50 1,424.50 610.50 594.508 1,062.00 1,042.00 732.78 1,042.00 20.00 413.00 8 1,062.00 1,042.00 743.40 1,042.00 20.00 413.009 1,565.00 1,042.00 1,079.85 1,079.85 485.15 365.15 9 1,565.00 1,042.00 1,095.50 1,095.50 469.50 349.5010 984.00 1,042.00 678.96 1,042.00 0.00 0.00 10 984.00 1,042.00 688.80 1,042.00 0.00 0.00

RATE CHART 7 - POLICE 2018 HEALTH PLAN RATESPOLICE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the Basic Plan that is determined by the percentage formula during the period the retiree is at least age 52 but less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the Basic Plan during the period after retirement the retiree is at least age 60 but less than age 65.

POLICE FAMILY ENROLLMENT - For a retiree with other than single enrollment status, the City will contribute an amount up the percentage of the subscriber cost for his/her enrollment status in the Basic Plan that is determined by the percentage formula during the period after retirement the retiree is at least age 52 but less than age 60 and the greater of either such amount or an amount up to 100% of the subscriber cost for single enrollment in the Basic Plan during the period after retirement the retiree is at least age 60 but less than age 65.

10/5/2017 2017 HEALTH PLAN RATES FOR POLICE AGE 60-64 (Less than 65) Rev: 9/??/2016

21 of 51 WEBSITE 2018 RETIREE RATE CHARTS\POL 6064

A B C D E F G I J K L M N OUHC CHOICE

PLUS UHC CHOICE UHC CHOICE PLUS UHC CHOICE

Plan 100% 100% 71% > of Retiree Retiree Plan 100% 100% 72% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 739.82 1,042.00 0.00 0.00 1 1,042.00 1,042.00 750.24 1,042.00 0.00 0.002 2,086.00 1,042.00 1,481.06 1,481.06 604.94 444.94 2 2,086.00 1,042.00 1,501.92 1,501.92 584.08 424.083 3,128.00 1,042.00 2,220.88 2,220.88 907.12 669.12 3 3,128.00 1,042.00 2,252.16 2,252.16 875.84 637.844 401.00 1,042.00 284.71 1,042.00 0.00 0.00 4 401.00 1,042.00 288.72 1,042.00 0.00 0.005 758.00 1,042.00 538.18 1,042.00 0.00 0.00 5 758.00 1,042.00 545.76 1,042.00 0.00 0.006 1,737.00 1,042.00 1,233.27 1,233.27 503.73 269.73 6 1,737.00 1,042.00 1,250.64 1,250.64 486.36 252.367 2,035.00 1,042.00 1,444.85 1,444.85 590.15 574.15 7 2,035.00 1,042.00 1,465.20 1,465.20 569.80 553.808 1,062.00 1,042.00 754.02 1,042.00 20.00 413.00 8 1,062.00 1,042.00 764.64 1,042.00 20.00 413.009 1,565.00 1,042.00 1,111.15 1,111.15 453.85 333.85 9 1,565.00 1,042.00 1,126.80 1,126.80 438.20 318.2010 984.00 1,042.00 698.64 1,042.00 0.00 0.00 10 984.00 1,042.00 708.48 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 73% > of Retiree Retiree Plan 100% 100% 74% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 760.66 1,042.00 0.00 0.00 1 1,042.00 1,042.00 771.08 1,042.00 0.00 0.002 2,086.00 1,042.00 1,522.78 1,522.78 563.22 403.22 2 2,086.00 1,042.00 1,543.64 1,543.64 542.36 382.363 3,128.00 1,042.00 2,283.44 2,283.44 844.56 606.56 3 3,128.00 1,042.00 2,314.72 2,314.72 813.28 575.284 401.00 1,042.00 292.73 1,042.00 0.00 0.00 4 401.00 1,042.00 296.74 1,042.00 0.00 0.005 758.00 1,042.00 553.34 1,042.00 0.00 0.00 5 758.00 1,042.00 560.92 1,042.00 0.00 0.006 1,737.00 1,042.00 1,268.01 1,268.01 468.99 234.99 6 1,737.00 1,042.00 1,285.38 1,285.38 451.62 217.627 2,035.00 1,042.00 1,485.55 1,485.55 549.45 533.45 7 2,035.00 1,042.00 1,505.90 1,505.90 529.10 513.108 1,062.00 1,042.00 775.26 1,042.00 20.00 413.00 8 1,062.00 1,042.00 785.88 1,042.00 20.00 413.009 1,565.00 1,042.00 1,142.45 1,142.45 422.55 302.55 9 1,565.00 1,042.00 1,158.10 1,158.10 406.90 286.9010 984.00 1,042.00 718.32 1,042.00 0.00 0.00 10 984.00 1,042.00 728.16 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 75% > of Retiree Retiree Plan 100% 100% 76% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 781.50 1,042.00 0.00 0.00 1 1,042.00 1,042.00 791.92 1,042.00 0.00 0.002 2,086.00 1,042.00 1,564.50 1,564.50 521.50 361.50 2 2,086.00 1,042.00 1,585.36 1,585.36 500.64 340.643 3,128.00 1,042.00 2,346.00 2,346.00 782.00 544.00 3 3,128.00 1,042.00 2,377.28 2,377.28 750.72 512.724 401.00 1,042.00 300.75 1,042.00 0.00 0.00 4 401.00 1,042.00 304.76 1,042.00 0.00 0.005 758.00 1,042.00 568.50 1,042.00 0.00 0.00 5 758.00 1,042.00 576.08 1,042.00 0.00 0.006 1,737.00 1,042.00 1,302.75 1,302.75 434.25 200.25 6 1,737.00 1,042.00 1,320.12 1,320.12 416.88 182.887 2,035.00 1,042.00 1,526.25 1,526.25 508.75 492.75 7 2,035.00 1,042.00 1,546.60 1,546.60 488.40 472.408 1,062.00 1,042.00 796.50 1,042.00 20.00 413.00 8 1,062.00 1,042.00 807.12 1,042.00 20.00 413.009 1,565.00 1,042.00 1,173.75 1,173.75 391.25 271.25 9 1,565.00 1,042.00 1,189.40 1,189.40 375.60 255.6010 984.00 1,042.00 738.00 1,042.00 0.00 0.00 10 984.00 1,042.00 747.84 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 77% > of Retiree Retiree Plan 100% 100% 78% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 802.34 1,042.00 0.00 0.00 1 1,042.00 1,042.00 812.76 1,042.00 0.00 0.002 2,086.00 1,042.00 1,606.22 1,606.22 479.78 319.78 2 2,086.00 1,042.00 1,627.08 1,627.08 458.92 298.923 3,128.00 1,042.00 2,408.56 2,408.56 719.44 481.44 3 3,128.00 1,042.00 2,439.84 2,439.84 688.16 450.164 401.00 1,042.00 308.77 1,042.00 0.00 0.00 4 401.00 1,042.00 312.78 1,042.00 0.00 0.005 758.00 1,042.00 583.66 1,042.00 0.00 0.00 5 758.00 1,042.00 591.24 1,042.00 0.00 0.006 1,737.00 1,042.00 1,337.49 1,337.49 399.51 165.51 6 1,737.00 1,042.00 1,354.86 1,354.86 382.14 148.147 2,035.00 1,042.00 1,566.95 1,566.95 468.05 452.05 7 2,035.00 1,042.00 1,587.30 1,587.30 447.70 431.708 1,062.00 1,042.00 817.74 1,042.00 20.00 413.00 8 1,062.00 1,042.00 828.36 1,042.00 20.00 413.009 1,565.00 1,042.00 1,205.05 1,205.05 359.95 239.95 9 1,565.00 1,042.00 1,220.70 1,220.70 344.30 224.3010 984.00 1,042.00 757.68 1,042.00 0.00 0.00 10 984.00 1,042.00 767.52 1,042.00 0.00 0.00

10/5/2017 2017 HEALTH PLAN RATES FOR POLICE AGE 60-64 (Less than 65) Rev: 9/??/2016

22 of 51 WEBSITE 2018 RETIREE RATE CHARTS\POL 6064

A B C D E F G I J K L M N OUHC CHOICE

PLUS UHC CHOICE UHC CHOICE PLUS UHC CHOICE

Plan 100% 100% 79% > of Retiree Retiree Plan 100% 100% 80% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 823.18 1,042.00 0.00 0.00 1 1,042.00 1,042.00 833.60 1,042.00 0.00 0.002 2,086.00 1,042.00 1,647.94 1,647.94 438.06 278.06 2 2,086.00 1,042.00 1,668.80 1,668.80 417.20 257.203 3,128.00 1,042.00 2,471.12 2,471.12 656.88 418.88 3 3,128.00 1,042.00 2,502.40 2,502.40 625.60 387.604 401.00 1,042.00 316.79 1,042.00 0.00 0.00 4 401.00 1,042.00 320.80 1,042.00 0.00 0.005 758.00 1,042.00 598.82 1,042.00 0.00 0.00 5 758.00 1,042.00 606.40 1,042.00 0.00 0.006 1,737.00 1,042.00 1,372.23 1,372.23 364.77 130.77 6 1,737.00 1,042.00 1,389.60 1,389.60 347.40 113.407 2,035.00 1,042.00 1,607.65 1,607.65 427.35 411.35 7 2,035.00 1,042.00 1,628.00 1,628.00 407.00 391.008 1,062.00 1,042.00 838.98 1,042.00 20.00 413.00 8 1,062.00 1,042.00 849.60 1,042.00 20.00 413.009 1,565.00 1,042.00 1,236.35 1,236.35 328.65 208.65 9 1,565.00 1,042.00 1,252.00 1,252.00 313.00 193.0010 984.00 1,042.00 777.36 1,042.00 0.00 0.00 10 984.00 1,042.00 787.20 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 81% > of Retiree Retiree Plan 100% 100% 82% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 844.02 1,042.00 0.00 0.00 1 1,042.00 1,042.00 854.44 1,042.00 0.00 0.002 2,086.00 1,042.00 1,689.66 1,689.66 396.34 236.34 2 2,086.00 1,042.00 1,710.52 1,710.52 375.48 215.483 3,128.00 1,042.00 2,533.68 2,533.68 594.32 356.32 3 3,128.00 1,042.00 2,564.96 2,564.96 563.04 325.044 401.00 1,042.00 324.81 1,042.00 0.00 0.00 4 401.00 1,042.00 328.82 1,042.00 0.00 0.005 758.00 1,042.00 613.98 1,042.00 0.00 0.00 5 758.00 1,042.00 621.56 1,042.00 0.00 0.006 1,737.00 1,042.00 1,406.97 1,406.97 330.03 96.03 6 1,737.00 1,042.00 1,424.34 1,424.34 312.66 78.667 2,035.00 1,042.00 1,648.35 1,648.35 386.65 370.65 7 2,035.00 1,042.00 1,668.70 1,668.70 366.30 350.308 1,062.00 1,042.00 860.22 1,042.00 20.00 413.00 8 1,062.00 1,042.00 870.84 1,042.00 20.00 413.009 1,565.00 1,042.00 1,267.65 1,267.65 297.35 177.35 9 1,565.00 1,042.00 1,283.30 1,283.30 281.70 161.7010 984.00 1,042.00 797.04 1,042.00 0.00 0.00 10 984.00 1,042.00 806.88 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 83% > of Retiree Retiree Plan 100% 100% 84% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 864.86 1,042.00 0.00 0.00 1 1,042.00 1,042.00 875.28 1,042.00 0.00 0.002 2,086.00 1,042.00 1,731.38 1,731.38 354.62 194.62 2 2,086.00 1,042.00 1,752.24 1,752.24 333.76 173.763 3,128.00 1,042.00 2,596.24 2,596.24 531.76 293.76 3 3,128.00 1,042.00 2,627.52 2,627.52 500.48 262.484 401.00 1,042.00 332.83 1,042.00 0.00 0.00 4 401.00 1,042.00 336.84 1,042.00 0.00 0.005 758.00 1,042.00 629.14 1,042.00 0.00 0.00 5 758.00 1,042.00 636.72 1,042.00 0.00 0.006 1,737.00 1,042.00 1,441.71 1,441.71 295.29 61.29 6 1,737.00 1,042.00 1,459.08 1,459.08 277.92 43.927 2,035.00 1,042.00 1,689.05 1,689.05 345.95 329.95 7 2,035.00 1,042.00 1,709.40 1,709.40 325.60 309.608 1,062.00 1,042.00 881.46 1,042.00 20.00 413.00 8 1,062.00 1,042.00 892.08 1,042.00 20.00 413.009 1,565.00 1,042.00 1,298.95 1,298.95 266.05 146.05 9 1,565.00 1,042.00 1,314.60 1,314.60 250.40 130.4010 984.00 1,042.00 816.72 1,042.00 0.00 0.00 10 984.00 1,042.00 826.56 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 85% > of Retiree Retiree Plan 100% 100% 86% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 885.70 1,042.00 0.00 0.00 1 1,042.00 1,042.00 896.12 1,042.00 0.00 0.002 2,086.00 1,042.00 1,773.10 1,773.10 312.90 152.90 2 2,086.00 1,042.00 1,793.96 1,793.96 292.04 132.043 3,128.00 1,042.00 2,658.80 2,658.80 469.20 231.20 3 3,128.00 1,042.00 2,690.08 2,690.08 437.92 199.924 401.00 1,042.00 340.85 1,042.00 0.00 0.00 4 401.00 1,042.00 344.86 1,042.00 0.00 0.005 758.00 1,042.00 644.30 1,042.00 0.00 0.00 5 758.00 1,042.00 651.88 1,042.00 0.00 0.006 1,737.00 1,042.00 1,476.45 1,476.45 260.55 26.55 6 1,737.00 1,042.00 1,493.82 1,493.82 243.18 9.187 2,035.00 1,042.00 1,729.75 1,729.75 305.25 289.25 7 2,035.00 1,042.00 1,750.10 1,750.10 284.90 268.908 1,062.00 1,042.00 902.70 1,042.00 20.00 413.00 8 1,062.00 1,042.00 913.32 1,042.00 20.00 413.009 1,565.00 1,042.00 1,330.25 1,330.25 234.75 114.75 9 1,565.00 1,042.00 1,345.90 1,345.90 219.10 99.1010 984.00 1,042.00 836.40 1,042.00 0.00 0.00 10 984.00 1,042.00 846.24 1,042.00 0.00 0.00

10/5/2017 2017 HEALTH PLAN RATES FOR POLICE AGE 60-64 (Less than 65) Rev: 9/??/2016

23 of 51 WEBSITE 2018 RETIREE RATE CHARTS\POL 6064

A B C D E F G I J K L M N OUHC CHOICE

PLUS UHC CHOICE UHC CHOICE PLUS UHC CHOICE

Plan 100% 100% 87% > of Retiree Retiree Plan 100% 100% 88% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 906.54 1,042.00 0.00 0.00 1 1,042.00 1,042.00 916.96 1,042.00 0.00 0.002 2,086.00 1,042.00 1,814.82 1,814.82 271.18 111.18 2 2,086.00 1,042.00 1,835.68 1,835.68 250.32 90.323 3,128.00 1,042.00 2,721.36 2,721.36 406.64 168.64 3 3,128.00 1,042.00 2,752.64 2,752.64 375.36 137.364 401.00 1,042.00 348.87 1,042.00 0.00 0.00 4 401.00 1,042.00 352.88 1,042.00 0.00 0.005 758.00 1,042.00 659.46 1,042.00 0.00 0.00 5 758.00 1,042.00 667.04 1,042.00 0.00 0.006 1,737.00 1,042.00 1,511.19 1,511.19 225.81 0.00 6 1,737.00 1,042.00 1,528.56 1,528.56 208.44 0.007 2,035.00 1,042.00 1,770.45 1,770.45 264.55 248.55 7 2,035.00 1,042.00 1,790.80 1,790.80 244.20 228.208 1,062.00 1,042.00 923.94 1,042.00 20.00 413.00 8 1,062.00 1,042.00 934.56 1,042.00 20.00 413.009 1,565.00 1,042.00 1,361.55 1,361.55 203.45 83.45 9 1,565.00 1,042.00 1,377.20 1,377.20 187.80 67.8010 984.00 1,042.00 856.08 1,042.00 0.00 0.00 10 984.00 1,042.00 865.92 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 89% > of Retiree Retiree Plan 100% 100% 90% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 927.38 1,042.00 0.00 0.00 1 1,042.00 1,042.00 937.80 1,042.00 0.00 0.002 2,086.00 1,042.00 1,856.54 1,856.54 229.46 69.46 2 2,086.00 1,042.00 1,877.40 1,877.40 208.60 48.603 3,128.00 1,042.00 2,783.92 2,783.92 344.08 106.08 3 3,128.00 1,042.00 2,815.20 2,815.20 312.80 74.804 401.00 1,042.00 356.89 1,042.00 0.00 0.00 4 401.00 1,042.00 360.90 1,042.00 0.00 0.005 758.00 1,042.00 674.62 1,042.00 0.00 0.00 5 758.00 1,042.00 682.20 1,042.00 0.00 0.006 1,737.00 1,042.00 1,545.93 1,545.93 191.07 0.00 6 1,737.00 1,042.00 1,563.30 1,563.30 173.70 0.007 2,035.00 1,042.00 1,811.15 1,811.15 223.85 207.85 7 2,035.00 1,042.00 1,831.50 1,831.50 203.50 187.508 1,062.00 1,042.00 945.18 1,042.00 20.00 413.00 8 1,062.00 1,042.00 955.80 1,042.00 20.00 413.009 1,565.00 1,042.00 1,392.85 1,392.85 172.15 52.15 9 1,565.00 1,042.00 1,408.50 1,408.50 156.50 36.5010 984.00 1,042.00 875.76 1,042.00 0.00 0.00 10 984.00 1,042.00 885.60 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 91% > of Retiree Retiree Plan 100% 100% 92% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 948.22 1,042.00 0.00 0.00 1 1,042.00 1,042.00 958.64 1,042.00 0.00 0.002 2,086.00 1,042.00 1,898.26 1,898.26 187.74 27.74 2 2,086.00 1,042.00 1,919.12 1,919.12 166.88 6.883 3,128.00 1,042.00 2,846.48 2,846.48 281.52 43.52 3 3,128.00 1,042.00 2,877.76 2,877.76 250.24 12.244 401.00 1,042.00 364.91 1,042.00 0.00 0.00 4 401.00 1,042.00 368.92 1,042.00 0.00 0.005 758.00 1,042.00 689.78 1,042.00 0.00 0.00 5 758.00 1,042.00 697.36 1,042.00 0.00 0.006 1,737.00 1,042.00 1,580.67 1,580.67 156.33 0.00 6 1,737.00 1,042.00 1,598.04 1,598.04 138.96 0.007 2,035.00 1,042.00 1,851.85 1,851.85 183.15 167.15 7 2,035.00 1,042.00 1,872.20 1,872.20 162.80 146.808 1,062.00 1,042.00 966.42 1,042.00 20.00 413.00 8 1,062.00 1,042.00 977.04 1,042.00 20.00 413.009 1,565.00 1,042.00 1,424.15 1,424.15 140.85 20.85 9 1,565.00 1,042.00 1,439.80 1,439.80 125.20 5.2010 984.00 1,042.00 895.44 1,042.00 0.00 0.00 10 984.00 1,042.00 905.28 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 93% > of Retiree Retiree Plan 100% 100% 94% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 969.06 1,042.00 0.00 0.00 1 1,042.00 1,042.00 979.48 1,042.00 0.00 0.002 2,086.00 1,042.00 1,939.98 1,939.98 146.02 0.00 2 2,086.00 1,042.00 1,960.84 1,960.84 125.16 0.003 3,128.00 1,042.00 2,909.04 2,909.04 218.96 0.00 3 3,128.00 1,042.00 2,940.32 2,940.32 187.68 0.004 401.00 1,042.00 372.93 1,042.00 0.00 0.00 4 401.00 1,042.00 376.94 1,042.00 0.00 0.005 758.00 1,042.00 704.94 1,042.00 0.00 0.00 5 758.00 1,042.00 712.52 1,042.00 0.00 0.006 1,737.00 1,042.00 1,615.41 1,615.41 121.59 0.00 6 1,737.00 1,042.00 1,632.78 1,632.78 104.22 0.007 2,035.00 1,042.00 1,892.55 1,892.55 142.45 126.45 7 2,035.00 1,042.00 1,912.90 1,912.90 122.10 106.108 1,062.00 1,042.00 987.66 1,042.00 20.00 413.00 8 1,062.00 1,042.00 998.28 1,042.00 20.00 413.009 1,565.00 1,042.00 1,455.45 1,455.45 109.55 0.00 9 1,565.00 1,042.00 1,471.10 1,471.10 93.90 0.0010 984.00 1,042.00 915.12 1,042.00 0.00 0.00 10 984.00 1,042.00 924.96 1,042.00 0.00 0.00

10/5/2017 2017 HEALTH PLAN RATES FOR POLICE AGE 60-64 (Less than 65) Rev: 9/??/2016

24 of 51 WEBSITE 2018 RETIREE RATE CHARTS\POL 6064

A B C D E F G I J K L M N OUHC CHOICE

PLUS UHC CHOICE UHC CHOICE PLUS UHC CHOICE

Plan 100% 100% 95% > of Retiree Retiree Plan 100% 100% 96% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 989.90 1,042.00 0.00 0.00 1 1,042.00 1,042.00 1,000.32 1,042.00 0.00 0.002 2,086.00 1,042.00 1,981.70 1,981.70 104.30 0.00 2 2,086.00 1,042.00 2,002.56 2,002.56 83.44 0.003 3,128.00 1,042.00 2,971.60 2,971.60 156.40 0.00 3 3,128.00 1,042.00 3,002.88 3,002.88 125.12 0.004 401.00 1,042.00 380.95 1,042.00 0.00 0.00 4 401.00 1,042.00 384.96 1,042.00 0.00 0.005 758.00 1,042.00 720.10 1,042.00 0.00 0.00 5 758.00 1,042.00 727.68 1,042.00 0.00 0.006 1,737.00 1,042.00 1,650.15 1,650.15 86.85 0.00 6 1,737.00 1,042.00 1,667.52 1,667.52 69.48 0.007 2,035.00 1,042.00 1,933.25 1,933.25 101.75 85.75 7 2,035.00 1,042.00 1,953.60 1,953.60 81.40 65.408 1,062.00 1,042.00 1,008.90 1,042.00 20.00 413.00 8 1,062.00 1,042.00 1,019.52 1,042.00 20.00 413.009 1,565.00 1,042.00 1,486.75 1,486.75 78.25 0.00 9 1,565.00 1,042.00 1,502.40 1,502.40 62.60 0.0010 984.00 1,042.00 934.80 1,042.00 0.00 0.00 10 984.00 1,042.00 944.64 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 97% > of Retiree Retiree Plan 100% 100% 98% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 1,010.74 1,042.00 0.00 0.00 1 1,042.00 1,042.00 1,021.16 1,042.00 0.00 0.002 2,086.00 1,042.00 2,023.42 2,023.42 62.58 0.00 2 2,086.00 1,042.00 2,044.28 2,044.28 41.72 0.003 3,128.00 1,042.00 3,034.16 3,034.16 93.84 0.00 3 3,128.00 1,042.00 3,065.44 3,065.44 62.56 0.004 401.00 1,042.00 388.97 1,042.00 0.00 0.00 4 401.00 1,042.00 392.98 1,042.00 0.00 0.005 758.00 1,042.00 735.26 1,042.00 0.00 0.00 5 758.00 1,042.00 742.84 1,042.00 0.00 0.006 1,737.00 1,042.00 1,684.89 1,684.89 52.11 0.00 6 1,737.00 1,042.00 1,702.26 1,702.26 34.74 0.007 2,035.00 1,042.00 1,973.95 1,973.95 61.05 45.05 7 2,035.00 1,042.00 1,994.30 1,994.30 40.70 24.708 1,062.00 1,042.00 1,030.14 1,042.00 20.00 413.00 8 1,062.00 1,042.00 1,040.76 1,042.00 20.00 413.009 1,565.00 1,042.00 1,518.05 1,518.05 46.95 0.00 9 1,565.00 1,042.00 1,533.70 1,533.70 31.30 0.0010 984.00 1,042.00 954.48 1,042.00 0.00 0.00 10 984.00 1,042.00 964.32 1,042.00 0.00 0.00

UHC CHOICE PLUS UHC CHOICE UHC CHOICE

PLUS UHC CHOICE

Plan 100% 100% 99% > of Retiree Retiree Plan 100% 100% 100% > of Retiree RetireeCode Rate Sgle Rate Formula C or D Pays Pays Code Rate Sgle Rate Formula C or D Pays Pays

1 1,042.00 1,042.00 1,031.58 1,042.00 0.00 0.00 1 1,042.00 1,042.00 1,042.00 1,042.00 0.00 0.002 2,086.00 1,042.00 2,065.14 2,065.14 20.86 0.00 2 2,086.00 1,042.00 2,086.00 2,086.00 0.00 0.003 3,128.00 1,042.00 3,096.72 3,096.72 31.28 0.00 3 3,128.00 1,042.00 3,128.00 3,128.00 0.00 0.004 401.00 1,042.00 396.99 1,042.00 0.00 0.00 4 401.00 1,042.00 401.00 1,042.00 0.00 0.005 758.00 1,042.00 750.42 1,042.00 0.00 0.00 5 758.00 1,042.00 758.00 1,042.00 0.00 0.006 1,737.00 1,042.00 1,719.63 1,719.63 17.37 0.00 6 1,737.00 1,042.00 1,737.00 1,737.00 0.00 0.007 2,035.00 1,042.00 2,014.65 2,014.65 20.35 4.35 7 2,035.00 1,042.00 2,035.00 2,035.00 0.00 0.008 1,062.00 1,042.00 1,051.38 1,051.38 10.62 403.62 8 1,062.00 1,042.00 1,062.00 1,062.00 0.00 393.009 1,565.00 1,042.00 1,549.35 1,549.35 15.65 0.00 9 1,565.00 1,042.00 1,565.00 1,565.00 0.00 0.0010 984.00 1,042.00 974.16 1,042.00 0.00 0.00 10 984.00 1,042.00 984.00 1,042.00 0.00 0.00

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 25 of 51Department of Employee Relations

City Hall, Room 706

UHC CHOICE PLUS (PPO)UHC CHOICE (EPO)

100% RETIREE PLAN RATES

PC Description UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 1,042.00$ 964.00$ 2 Two Adults w/o Medicare 2,086.00$ 1,926.00$ 3 Two Adults & Dependent Child(ren) 3,128.00$ 2,890.00$ 4 One Adult with Medicare 401.00$ 469.00$ 5 Two Adults with Medicare 758.00$ 938.00$ 6 One Adult with Medicare, One person w/o Medicare 1,737.00$ 1,503.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 2,035.00$ 2,019.00$ 8 Two Adults with Medicare & Dependent Child(ren) 1,062.00$ 1,455.00$ 9 Adult & Dependent Child(ren) 1,565.00$ 1,445.00$

10 Adult with Medicare & Dependent Child(ren) 984.00$ 986.00$

RATE CHART 7 - FULL 2018 RATEFIRE - EXCEED 40 HRS PER WEEK

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 26 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 65% City Contribution Unused S/L - Less than 70 work days

PC Description @65% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 364.70$ 286.70$ 2 Two Adults w/o Medicare 730.10$ 570.10$ 3 Two Adults & Dependent Child(ren) 1,094.80$ 856.80$ 4 One Adult with Medicare 140.35$ 208.35$ 5 Two Adults with Medicare 265.30$ 445.30$ 6 One Adult with Medicare, One person w/o Medicare 607.95$ 373.95$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 712.25$ 696.25$ 8 Two Adults with Medicare & Dependent Child(ren) 371.70$ 764.70$ 9 Adult & Dependent Child(ren) 547.75$ 427.75$

10 Adult with Medicare & Dependent Child(ren) 344.40$ 346.40$ FIRE (Exceed 40hrs/wk)

@ 66% City Contribution Unused S/L - At least 70 but less than 74

work days

PC Description @66% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 354.28$ 276.28$ 2 Two Adults w/o Medicare 709.24$ 549.24$ 3 Two Adults & Dependent Child(ren) 1,063.52$ 825.52$ 4 One Adult with Medicare 136.34$ 204.34$ 5 Two Adults with Medicare 257.72$ 437.72$ 6 One Adult with Medicare, One person w/o Medicare 590.58$ 356.58$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 691.90$ 675.90$ 8 Two Adults with Medicare & Dependent Child(ren) 361.08$ 754.08$ 9 Adult & Dependent Child(ren) 532.10$ 412.10$

10 Adult with Medicare & Dependent Child(ren) 334.56$ 336.56$ FIRE (Exceed 40hrs/wk)

@ 67% City Contribution Unused S/L - At least 74 but less than 78

work days

PC Description @67% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 343.86$ 265.86$ 2 Two Adults w/o Medicare 688.38$ 528.38$ 3 Two Adults & Dependent Child(ren) 1,032.24$ 794.24$ 4 One Adult with Medicare 132.33$ 200.33$ 5 Two Adults with Medicare 250.14$ 430.14$ 6 One Adult with Medicare, One person w/o Medicare 573.21$ 339.21$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 671.55$ 655.55$ 8 Two Adults with Medicare & Dependent Child(ren) 350.46$ 743.46$ 9 Adult & Dependent Child(ren) 516.45$ 396.45$

10 Adult with Medicare & Dependent Child(ren) 324.72$ 326.72$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 27 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 68% City Contribution Unused S/L - At least 78 but less than 82

work days

PC Description @68% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 333.44$ 255.44$ 2 Two Adults w/o Medicare 667.52$ 507.52$ 3 Two Adults & Dependent Child(ren) 1,000.96$ 762.96$ 4 One Adult with Medicare 128.32$ 196.32$ 5 Two Adults with Medicare 242.56$ 422.56$ 6 One Adult with Medicare, One person w/o Medicare 555.84$ 321.84$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 651.20$ 635.20$ 8 Two Adults with Medicare & Dependent Child(ren) 339.84$ 732.84$ 9 Adult & Dependent Child(ren) 500.80$ 380.80$

10 Adult with Medicare & Dependent Child(ren) 314.88$ 316.88$ FIRE (Exceed 40hrs/wk)

@ 69% City Contribution Unused S/L - At least 82 but less than 86

work days

PC Description @69% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 323.02$ 245.02$ 2 Two Adults w/o Medicare 646.66$ 486.66$ 3 Two Adults & Dependent Child(ren) 969.68$ 731.68$ 4 One Adult with Medicare 124.31$ 192.31$ 5 Two Adults with Medicare 234.98$ 414.98$ 6 One Adult with Medicare, One person w/o Medicare 538.47$ 304.47$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 630.85$ 614.85$ 8 Two Adults with Medicare & Dependent Child(ren) 329.22$ 722.22$ 9 Adult & Dependent Child(ren) 485.15$ 365.15$

10 Adult with Medicare & Dependent Child(ren) 305.04$ 307.04$ FIRE (Exceed 40hrs/wk)

@ 70% City Contribution Unused S/L - At least 86 but less than 90

work days

PC Description @70% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 312.60$ 234.60$ 2 Two Adults w/o Medicare 625.80$ 465.80$ 3 Two Adults & Dependent Child(ren) 938.40$ 700.40$ 4 One Adult with Medicare 120.30$ 188.30$ 5 Two Adults with Medicare 227.40$ 407.40$ 6 One Adult with Medicare, One person w/o Medicare 521.10$ 287.10$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 610.50$ 594.50$ 8 Two Adults with Medicare & Dependent Child(ren) 318.60$ 711.60$ 9 Adult & Dependent Child(ren) 469.50$ 349.50$

10 Adult with Medicare & Dependent Child(ren) 295.20$ 297.20$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 28 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 71% City Contribution Unused S/L - At least 90 but less than 94

work days

PC Description @71% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 302.18$ 224.18$ 2 Two Adults w/o Medicare 604.94$ 444.94$ 3 Two Adults & Dependent Child(ren) 907.12$ 669.12$ 4 One Adult with Medicare 116.29$ 184.29$ 5 Two Adults with Medicare 219.82$ 399.82$ 6 One Adult with Medicare, One person w/o Medicare 503.73$ 269.73$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 590.15$ 574.15$ 8 Two Adults with Medicare & Dependent Child(ren) 307.98$ 700.98$ 9 Adult & Dependent Child(ren) 453.85$ 333.85$

10 Adult with Medicare & Dependent Child(ren) 285.36$ 287.36$ FIRE (Exceed 40hrs/wk)

@ 72% City Contribution Unused S/L - At least 94 but less than 98

work days

PC Description @72% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 291.76$ 213.76$ 2 Two Adults w/o Medicare 584.08$ 424.08$ 3 Two Adults & Dependent Child(ren) 875.84$ 637.84$ 4 One Adult with Medicare 112.28$ 180.28$ 5 Two Adults with Medicare 212.24$ 392.24$ 6 One Adult with Medicare, One person w/o Medicare 486.36$ 252.36$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 569.80$ 553.80$ 8 Two Adults with Medicare & Dependent Child(ren) 297.36$ 690.36$ 9 Adult & Dependent Child(ren) 438.20$ 318.20$

10 Adult with Medicare & Dependent Child(ren) 275.52$ 277.52$ FIRE (Exceed 40hrs/wk)

@ 73% City Contribution Unused S/L - At least 98 but less than 102

work days

PC Description @73% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 281.34$ 203.34$ 2 Two Adults w/o Medicare 563.22$ 403.22$ 3 Two Adults & Dependent Child(ren) 844.56$ 606.56$ 4 One Adult with Medicare 108.27$ 176.27$ 5 Two Adults with Medicare 204.66$ 384.66$ 6 One Adult with Medicare, One person w/o Medicare 468.99$ 234.99$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 549.45$ 533.45$ 8 Two Adults with Medicare & Dependent Child(ren) 286.74$ 679.74$ 9 Adult & Dependent Child(ren) 422.55$ 302.55$

10 Adult with Medicare & Dependent Child(ren) 265.68$ 267.68$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 29 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 74% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 102 but less than 106 work days

PC Description @74% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 270.92$ 192.92$ 2 Two Adults w/o Medicare 542.36$ 382.36$ 3 Two Adults & Dependent Child(ren) 813.28$ 575.28$ 4 One Adult with Medicare 104.26$ 172.26$ 5 Two Adults with Medicare 197.08$ 377.08$ 6 One Adult with Medicare, One person w/o Medicare 451.62$ 217.62$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 529.10$ 513.10$ 8 Two Adults with Medicare & Dependent Child(ren) 276.12$ 669.12$ 9 Adult & Dependent Child(ren) 406.90$ 286.90$

10 Adult with Medicare & Dependent Child(ren) 255.84$ 257.84$ FIRE (Exceed 40hrs/wk)

@ 75% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 106 but less than 110 work days

PC Description @75% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 260.50$ 182.50$ 2 Two Adults w/o Medicare 521.50$ 361.50$ 3 Two Adults & Dependent Child(ren) 782.00$ 544.00$ 4 One Adult with Medicare 100.25$ 168.25$ 5 Two Adults with Medicare 189.50$ 369.50$ 6 One Adult with Medicare, One person w/o Medicare 434.25$ 200.25$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 508.75$ 492.75$ 8 Two Adults with Medicare & Dependent Child(ren) 265.50$ 658.50$ 9 Adult & Dependent Child(ren) 391.25$ 271.25$

10 Adult with Medicare & Dependent Child(ren) 246.00$ 248.00$ FIRE (Exceed 40hrs/wk)

@ 76% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 110 but less than 114 work days

PC Description @76% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 250.08$ 172.08$ 2 Two Adults w/o Medicare 500.64$ 340.64$ 3 Two Adults & Dependent Child(ren) 750.72$ 512.72$ 4 One Adult with Medicare 96.24$ 164.24$ 5 Two Adults with Medicare 181.92$ 361.92$ 6 One Adult with Medicare, One person w/o Medicare 416.88$ 182.88$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 488.40$ 472.40$ 8 Two Adults with Medicare & Dependent Child(ren) 254.88$ 647.88$ 9 Adult & Dependent Child(ren) 375.60$ 255.60$

10 Adult with Medicare & Dependent Child(ren) 236.16$ 238.16$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 30 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 77% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 114 but less than 118 work days

PC Description @77% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 239.66$ 161.66$ 2 Two Adults w/o Medicare 479.78$ 319.78$ 3 Two Adults & Dependent Child(ren) 719.44$ 481.44$ 4 One Adult with Medicare 92.23$ 160.23$ 5 Two Adults with Medicare 174.34$ 354.34$ 6 One Adult with Medicare, One person w/o Medicare 399.51$ 165.51$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 468.05$ 452.05$ 8 Two Adults with Medicare & Dependent Child(ren) 244.26$ 637.26$ 9 Adult & Dependent Child(ren) 359.95$ 239.95$

10 Adult with Medicare & Dependent Child(ren) 226.32$ 228.32$ FIRE (Exceed 40hrs/wk)

@ 78% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 118 but less than 122 work days

PC Description @78% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 229.24$ 151.24$ 2 Two Adults w/o Medicare 458.92$ 298.92$ 3 Two Adults & Dependent Child(ren) 688.16$ 450.16$ 4 One Adult with Medicare 88.22$ 156.22$ 5 Two Adults with Medicare 166.76$ 346.76$ 6 One Adult with Medicare, One person w/o Medicare 382.14$ 148.14$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 447.70$ 431.70$ 8 Two Adults with Medicare & Dependent Child(ren) 233.64$ 626.64$ 9 Adult & Dependent Child(ren) 344.30$ 224.30$

10 Adult with Medicare & Dependent Child(ren) 216.48$ 218.48$ FIRE (Exceed 40hrs/wk)

@ 79% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 122 but less than 126 work days

PC Description @79% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 218.82$ 140.82$ 2 Two Adults w/o Medicare 438.06$ 278.06$ 3 Two Adults & Dependent Child(ren) 656.88$ 418.88$ 4 One Adult with Medicare 84.21$ 152.21$ 5 Two Adults with Medicare 159.18$ 339.18$ 6 One Adult with Medicare, One person w/o Medicare 364.77$ 130.77$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 427.35$ 411.35$ 8 Two Adults with Medicare & Dependent Child(ren) 223.02$ 616.02$ 9 Adult & Dependent Child(ren) 328.65$ 208.65$

10 Adult with Medicare & Dependent Child(ren) 206.64$ 208.64$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 31 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 80% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 126 but less than 130 work days

PC Description @80% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 208.40$ 130.40$ 2 Two Adults w/o Medicare 417.20$ 257.20$ 3 Two Adults & Dependent Child(ren) 625.60$ 387.60$ 4 One Adult with Medicare 80.20$ 148.20$ 5 Two Adults with Medicare 151.60$ 331.60$ 6 One Adult with Medicare, One person w/o Medicare 347.40$ 113.40$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 407.00$ 391.00$ 8 Two Adults with Medicare & Dependent Child(ren) 212.40$ 605.40$ 9 Adult & Dependent Child(ren) 313.00$ 193.00$

10 Adult with Medicare & Dependent Child(ren) 196.80$ 198.80$ FIRE (Exceed 40hrs/wk)

@ 81% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 130 but less than 133 work days

PC Description @81% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 197.98$ 119.98$ 2 Two Adults w/o Medicare 396.34$ 236.34$ 3 Two Adults & Dependent Child(ren) 594.32$ 356.32$ 4 One Adult with Medicare 76.19$ 144.19$ 5 Two Adults with Medicare 144.02$ 324.02$ 6 One Adult with Medicare, One person w/o Medicare 330.03$ 96.03$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 386.65$ 370.65$ 8 Two Adults with Medicare & Dependent Child(ren) 201.78$ 594.78$ 9 Adult & Dependent Child(ren) 297.35$ 177.35$

10 Adult with Medicare & Dependent Child(ren) 186.96$ 188.96$ FIRE (Exceed 40hrs/wk)

@ 82% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 133 but less than 136 work days

PC Description @82% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 187.56$ 109.56$ 2 Two Adults w/o Medicare 375.48$ 215.48$ 3 Two Adults & Dependent Child(ren) 563.04$ 325.04$ 4 One Adult with Medicare 72.18$ 140.18$ 5 Two Adults with Medicare 136.44$ 316.44$ 6 One Adult with Medicare, One person w/o Medicare 312.66$ 78.66$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 366.30$ 350.30$ 8 Two Adults with Medicare & Dependent Child(ren) 191.16$ 584.16$ 9 Adult & Dependent Child(ren) 281.70$ 161.70$

10 Adult with Medicare & Dependent Child(ren) 177.12$ 179.12$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 32 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 83% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 136 but less than 139 work days

PC Description @83% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 177.14$ 99.14$ 2 Two Adults w/o Medicare 354.62$ 194.62$ 3 Two Adults & Dependent Child(ren) 531.76$ 293.76$ 4 One Adult with Medicare 68.17$ 136.17$ 5 Two Adults with Medicare 128.86$ 308.86$ 6 One Adult with Medicare, One person w/o Medicare 295.29$ 61.29$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 345.95$ 329.95$ 8 Two Adults with Medicare & Dependent Child(ren) 180.54$ 573.54$ 9 Adult & Dependent Child(ren) 266.05$ 146.05$

10 Adult with Medicare & Dependent Child(ren) 167.28$ 169.28$ FIRE (Exceed 40hrs/wk)

@ 84% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 139 but less than 142 work days

PC Description @84% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 166.72$ 88.72$ 2 Two Adults w/o Medicare 333.76$ 173.76$ 3 Two Adults & Dependent Child(ren) 500.48$ 262.48$ 4 One Adult with Medicare 64.16$ 132.16$ 5 Two Adults with Medicare 121.28$ 301.28$ 6 One Adult with Medicare, One person w/o Medicare 277.92$ 43.92$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 325.60$ 309.60$ 8 Two Adults with Medicare & Dependent Child(ren) 169.92$ 562.92$ 9 Adult & Dependent Child(ren) 250.40$ 130.40$

10 Adult with Medicare & Dependent Child(ren) 157.44$ 159.44$ FIRE (Exceed 40hrs/wk)

@ 85% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 142 but less than 145 work days

PC Description @85% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 156.30$ 78.30$ 2 Two Adults w/o Medicare 312.90$ 152.90$ 3 Two Adults & Dependent Child(ren) 469.20$ 231.20$ 4 One Adult with Medicare 60.15$ 128.15$ 5 Two Adults with Medicare 113.70$ 293.70$ 6 One Adult with Medicare, One person w/o Medicare 260.55$ 26.55$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 305.25$ 289.25$ 8 Two Adults with Medicare & Dependent Child(ren) 159.30$ 552.30$ 9 Adult & Dependent Child(ren) 234.75$ 114.75$

10 Adult with Medicare & Dependent Child(ren) 147.60$ 149.60$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 33 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 86% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 145 but less than 148 work days

PC Description @86% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 145.88$ 67.88$ 2 Two Adults w/o Medicare 292.04$ 132.04$ 3 Two Adults & Dependent Child(ren) 437.92$ 199.92$ 4 One Adult with Medicare 56.14$ 124.14$ 5 Two Adults with Medicare 106.12$ 286.12$ 6 One Adult with Medicare, One person w/o Medicare 243.18$ 9.18$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 284.90$ 268.90$ 8 Two Adults with Medicare & Dependent Child(ren) 148.68$ 541.68$ 9 Adult & Dependent Child(ren) 219.10$ 99.10$

10 Adult with Medicare & Dependent Child(ren) 137.76$ 139.76$ FIRE (Exceed 40hrs/wk)

@ 87% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 148 but less than 151 work days

PC Description @87% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 135.46$ 57.46$ 2 Two Adults w/o Medicare 271.18$ 111.18$ 3 Two Adults & Dependent Child(ren) 406.64$ 168.64$ 4 One Adult with Medicare 52.13$ 120.13$ 5 Two Adults with Medicare 98.54$ 278.54$ 6 One Adult with Medicare, One person w/o Medicare 225.81$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 264.55$ 248.55$ 8 Two Adults with Medicare & Dependent Child(ren) 138.06$ 531.06$ 9 Adult & Dependent Child(ren) 203.45$ 83.45$

10 Adult with Medicare & Dependent Child(ren) 127.92$ 129.92$ FIRE (Exceed 40hrs/wk)

@ 88% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 151 but less than 154 work days

PC Description @88% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 125.04$ 47.04$ 2 Two Adults w/o Medicare 250.32$ 90.32$ 3 Two Adults & Dependent Child(ren) 375.36$ 137.36$ 4 One Adult with Medicare 48.12$ 116.12$ 5 Two Adults with Medicare 90.96$ 270.96$ 6 One Adult with Medicare, One person w/o Medicare 208.44$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 244.20$ 228.20$ 8 Two Adults with Medicare & Dependent Child(ren) 127.44$ 520.44$ 9 Adult & Dependent Child(ren) 187.80$ 67.80$

10 Adult with Medicare & Dependent Child(ren) 118.08$ 120.08$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 34 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 89% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 154 but less than 157 work days

PC Description @89% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 114.62$ 36.62$ 2 Two Adults w/o Medicare 229.46$ 69.46$ 3 Two Adults & Dependent Child(ren) 344.08$ 106.08$ 4 One Adult with Medicare 44.11$ 112.11$ 5 Two Adults with Medicare 83.38$ 263.38$ 6 One Adult with Medicare, One person w/o Medicare 191.07$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 223.85$ 207.85$ 8 Two Adults with Medicare & Dependent Child(ren) 116.82$ 509.82$ 9 Adult & Dependent Child(ren) 172.15$ 52.15$

10 Adult with Medicare & Dependent Child(ren) 108.24$ 110.24$ FIRE (Exceed 40hrs/wk)

@ 90% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 157 but less than 160 work days

PC Description @90% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 104.20$ 26.20$ 2 Two Adults w/o Medicare 208.60$ 48.60$ 3 Two Adults & Dependent Child(ren) 312.80$ 74.80$ 4 One Adult with Medicare 40.10$ 108.10$ 5 Two Adults with Medicare 75.80$ 255.80$ 6 One Adult with Medicare, One person w/o Medicare 173.70$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 203.50$ 187.50$ 8 Two Adults with Medicare & Dependent Child(ren) 106.20$ 499.20$ 9 Adult & Dependent Child(ren) 156.50$ 36.50$

10 Adult with Medicare & Dependent Child(ren) 98.40$ 100.40$ FIRE (Exceed 40hrs/wk)

@ 91% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 160 but less than 163 work days

PC Description @91% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 93.78$ 15.78$ 2 Two Adults w/o Medicare 187.74$ 27.74$ 3 Two Adults & Dependent Child(ren) 281.52$ 43.52$ 4 One Adult with Medicare 36.09$ 104.09$ 5 Two Adults with Medicare 68.22$ 248.22$ 6 One Adult with Medicare, One person w/o Medicare 156.33$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 183.15$ 167.15$ 8 Two Adults with Medicare & Dependent Child(ren) 95.58$ 488.58$ 9 Adult & Dependent Child(ren) 140.85$ 20.85$

10 Adult with Medicare & Dependent Child(ren) 88.56$ 90.56$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 35 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 92% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 163 but less than 166 work days

PC Description @92% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 83.36$ 5.36$ 2 Two Adults w/o Medicare 166.88$ 6.88$ 3 Two Adults & Dependent Child(ren) 250.24$ 12.24$ 4 One Adult with Medicare 32.08$ 100.08$ 5 Two Adults with Medicare 60.64$ 240.64$ 6 One Adult with Medicare, One person w/o Medicare 138.96$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 162.80$ 146.80$ 8 Two Adults with Medicare & Dependent Child(ren) 84.96$ 477.96$ 9 Adult & Dependent Child(ren) 125.20$ 5.20$

10 Adult with Medicare & Dependent Child(ren) 78.72$ 80.72$ FIRE (Exceed 40hrs/wk)

@ 93% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 166 but less than 169 work days

PC Description @93% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 72.94$ -$ 2 Two Adults w/o Medicare 146.02$ -$ 3 Two Adults & Dependent Child(ren) 218.96$ -$ 4 One Adult with Medicare 28.07$ 96.07$ 5 Two Adults with Medicare 53.06$ 233.06$ 6 One Adult with Medicare, One person w/o Medicare 121.59$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 142.45$ 126.45$ 8 Two Adults with Medicare & Dependent Child(ren) 74.34$ 467.34$ 9 Adult & Dependent Child(ren) 109.55$ -$

10 Adult with Medicare & Dependent Child(ren) 68.88$ 70.88$ FIRE (Exceed 40hrs/wk)

@ 94% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 169 but less than 172 work days

PC Description @94% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 62.52$ -$ 2 Two Adults w/o Medicare 125.16$ -$ 3 Two Adults & Dependent Child(ren) 187.68$ -$ 4 One Adult with Medicare 24.06$ 92.06$ 5 Two Adults with Medicare 45.48$ 225.48$ 6 One Adult with Medicare, One person w/o Medicare 104.22$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 122.10$ 106.10$ 8 Two Adults with Medicare & Dependent Child(ren) 63.72$ 456.72$ 9 Adult & Dependent Child(ren) 93.90$ -$

10 Adult with Medicare & Dependent Child(ren) 59.04$ 61.04$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 36 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 95% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 172 but less than 175 work days

PC Description @95% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 52.10$ -$ 2 Two Adults w/o Medicare 104.30$ -$ 3 Two Adults & Dependent Child(ren) 156.40$ -$ 4 One Adult with Medicare 20.05$ 88.05$ 5 Two Adults with Medicare 37.90$ 217.90$ 6 One Adult with Medicare, One person w/o Medicare 86.85$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 101.75$ 85.75$ 8 Two Adults with Medicare & Dependent Child(ren) 53.10$ 446.10$ 9 Adult & Dependent Child(ren) 78.25$ -$

10 Adult with Medicare & Dependent Child(ren) 49.20$ 51.20$ FIRE (Exceed 40hrs/wk)

@ 96% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 175 but less than 178 work days

PC Description @96% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 41.68$ -$ 2 Two Adults w/o Medicare 83.44$ -$ 3 Two Adults & Dependent Child(ren) 125.12$ -$ 4 One Adult with Medicare 16.04$ 84.04$ 5 Two Adults with Medicare 30.32$ 210.32$ 6 One Adult with Medicare, One person w/o Medicare 69.48$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 81.40$ 65.40$ 8 Two Adults with Medicare & Dependent Child(ren) 42.48$ 435.48$ 9 Adult & Dependent Child(ren) 62.60$ -$

10 Adult with Medicare & Dependent Child(ren) 39.36$ 41.36$ FIRE (Exceed 40hrs/wk)

@ 97% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 178 but less than 181 work days

PC Description @97% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 31.26$ -$ 2 Two Adults w/o Medicare 62.58$ -$ 3 Two Adults & Dependent Child(ren) 93.84$ -$ 4 One Adult with Medicare 12.03$ 80.03$ 5 Two Adults with Medicare 22.74$ 202.74$ 6 One Adult with Medicare, One person w/o Medicare 52.11$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 61.05$ 45.05$ 8 Two Adults with Medicare & Dependent Child(ren) 31.86$ 424.86$ 9 Adult & Dependent Child(ren) 46.95$ -$

10 Adult with Medicare & Dependent Child(ren) 29.52$ 31.52$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 37 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 98% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 181 but less than 184 work days

PC Description @98% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 20.84$ -$ 2 Two Adults w/o Medicare 41.72$ -$ 3 Two Adults & Dependent Child(ren) 62.56$ -$ 4 One Adult with Medicare 8.02$ 76.02$ 5 Two Adults with Medicare 15.16$ 195.16$ 6 One Adult with Medicare, One person w/o Medicare 34.74$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 40.70$ 24.70$ 8 Two Adults with Medicare & Dependent Child(ren) 21.24$ 414.24$ 9 Adult & Dependent Child(ren) 31.30$ -$

10 Adult with Medicare & Dependent Child(ren) 19.68$ 21.68$ FIRE (Exceed 40hrs/wk)

@ 99% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 184 but less than 187 work days

PC Description @99% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare 10.42$ -$ 2 Two Adults w/o Medicare 20.86$ -$ 3 Two Adults & Dependent Child(ren) 31.28$ -$ 4 One Adult with Medicare 4.01$ 72.01$ 5 Two Adults with Medicare 7.58$ 187.58$ 6 One Adult with Medicare, One person w/o Medicare 17.37$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 20.35$ 4.35$ 8 Two Adults with Medicare & Dependent Child(ren) 10.62$ 403.62$ 9 Adult & Dependent Child(ren) 15.65$ -$

10 Adult with Medicare & Dependent Child(ren) 9.84$ 11.84$ FIRE (Exceed 40hrs/wk)

@ 100% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 187 work days

PC Description @100% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare -$ -$ 3 Two Adults & Dependent Child(ren) -$ -$ 4 One Adult with Medicare -$ 68.00$ 5 Two Adults with Medicare -$ 180.00$ 6 One Adult with Medicare, One person w/o Medicare -$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) -$ -$ 8 Two Adults with Medicare & Dependent Child(ren) -$ 393.00$ 9 Adult & Dependent Child(ren) -$ -$

10 Adult with Medicare & Dependent Child(ren) -$ 2.00$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 38 of 51Department of Employee Relations

City Hall, Room 706

UHC CHOICE PLUS (PPO)UHC CHOICE (EPO)

100% RETIREE PLAN RATES

PC Description UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 2,086.00$ 1,926.00$ 3 Two Adults & Dependent Child(ren) 3,128.00$ 2,890.00$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 758.00$ 938.00$ 6 One Adult with Medicare, One person w/o Medicare 1,737.00$ 1,503.00$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 2,035.00$ 2,019.00$ 8 Two Adults with Medicare & Dependent Child(ren) 1,062.00$ 1,455.00$ 9 Adult & Dependent Child(ren) 1,565.00$ 1,445.00$

10 Adult with Medicare & Dependent Child(ren) 984.00$ 986.00$

FIRE SINGLE ENROLLMENT - For a retiree with single enrollment status, the City will contribute an amount up to the percentage of the subscriber cost for single enrollment in the Basic Plan that is determined by the percentage formula

during the period the retiree is at least age 52 but less than age 60 and an amount up to 100% of the subscriber cost for single enrollment in the Basic Plan during the period after retirement the retiree is at least age 60 but less than age 65.

RATE CHART 7 - FULL 2018 RATEFIRE - EXCEED 40 HRS PER WEEK - Ages 60 - 64

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 39 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 65% City Contribution Unused S/L - Less than 70 work days

PC Description @65% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 730.10$ 570.10$ 3 Two Adults & Dependent Child(ren) 1,094.80$ 856.80$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 265.30$ 445.30$ 6 One Adult with Medicare, One person w/o Medicare 607.95$ 373.95$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 712.25$ 696.25$ 8 Two Adults with Medicare & Dependent Child(ren) 371.70$ 764.70$ 9 Adult & Dependent Child(ren) 547.75$ 427.75$

10 Adult with Medicare & Dependent Child(ren) 344.40$ 346.40$ FIRE (Exceed 40hrs/wk)

@ 66% City Contribution Unused S/L - At least 70 but less than 74

work days

PC Description @66% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 709.24$ 549.24$ 3 Two Adults & Dependent Child(ren) 1,063.52$ 825.52$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 257.72$ 437.72$ 6 One Adult with Medicare, One person w/o Medicare 590.58$ 356.58$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 691.90$ 675.90$ 8 Two Adults with Medicare & Dependent Child(ren) 361.08$ 754.08$ 9 Adult & Dependent Child(ren) 532.10$ 412.10$

10 Adult with Medicare & Dependent Child(ren) 334.56$ 336.56$ FIRE (Exceed 40hrs/wk)

@ 67% City Contribution Unused S/L - At least 74 but less than 78

work days

PC Description @67% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 688.38$ 528.38$ 3 Two Adults & Dependent Child(ren) 1,032.24$ 794.24$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 250.14$ 430.14$ 6 One Adult with Medicare, One person w/o Medicare 573.21$ 339.21$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 671.55$ 655.55$ 8 Two Adults with Medicare & Dependent Child(ren) 350.46$ 743.46$ 9 Adult & Dependent Child(ren) 516.45$ 396.45$

10 Adult with Medicare & Dependent Child(ren) 324.72$ 326.72$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 40 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 68% City Contribution Unused S/L - At least 78 but less than 82

work days

PC Description @68% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 667.52$ 507.52$ 3 Two Adults & Dependent Child(ren) 1,000.96$ 762.96$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 242.56$ 422.56$ 6 One Adult with Medicare, One person w/o Medicare 555.84$ 321.84$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 651.20$ 635.20$ 8 Two Adults with Medicare & Dependent Child(ren) 339.84$ 732.84$ 9 Adult & Dependent Child(ren) 500.80$ 380.80$

10 Adult with Medicare & Dependent Child(ren) 314.88$ 316.88$ FIRE (Exceed 40hrs/wk)

@ 69% City Contribution Unused S/L - At least 82 but less than 86

work days

PC Description @69% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 646.66$ 486.66$ 3 Two Adults & Dependent Child(ren) 969.68$ 731.68$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 234.98$ 414.98$ 6 One Adult with Medicare, One person w/o Medicare 538.47$ 304.47$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 630.85$ 614.85$ 8 Two Adults with Medicare & Dependent Child(ren) 329.22$ 722.22$ 9 Adult & Dependent Child(ren) 485.15$ 365.15$

10 Adult with Medicare & Dependent Child(ren) 305.04$ 307.04$ FIRE (Exceed 40hrs/wk)

@ 70% City Contribution Unused S/L - At least 86 but less than 90

work days

PC Description @70% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 625.80$ 465.80$ 3 Two Adults & Dependent Child(ren) 938.40$ 700.40$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 227.40$ 407.40$ 6 One Adult with Medicare, One person w/o Medicare 521.10$ 287.10$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 610.50$ 594.50$ 8 Two Adults with Medicare & Dependent Child(ren) 318.60$ 711.60$ 9 Adult & Dependent Child(ren) 469.50$ 349.50$

10 Adult with Medicare & Dependent Child(ren) 295.20$ 297.20$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 41 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 71% City Contribution Unused S/L - At least 90 but less than 94

work days

PC Description @71% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 604.94$ 444.94$ 3 Two Adults & Dependent Child(ren) 907.12$ 669.12$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 219.82$ 399.82$ 6 One Adult with Medicare, One person w/o Medicare 503.73$ 269.73$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 590.15$ 574.15$ 8 Two Adults with Medicare & Dependent Child(ren) 307.98$ 700.98$ 9 Adult & Dependent Child(ren) 453.85$ 333.85$

10 Adult with Medicare & Dependent Child(ren) 285.36$ 287.36$ FIRE (Exceed 40hrs/wk)

@ 72% City Contribution Unused S/L - At least 94 but less than 98

work days

PC Description @72% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 584.08$ 424.08$ 3 Two Adults & Dependent Child(ren) 875.84$ 637.84$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 212.24$ 392.24$ 6 One Adult with Medicare, One person w/o Medicare 486.36$ 252.36$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 569.80$ 553.80$ 8 Two Adults with Medicare & Dependent Child(ren) 297.36$ 690.36$ 9 Adult & Dependent Child(ren) 438.20$ 318.20$

10 Adult with Medicare & Dependent Child(ren) 275.52$ 277.52$ FIRE (Exceed 40hrs/wk)

@ 73% City Contribution Unused S/L - At least 98 but less than 102

work days

PC Description @73% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 563.22$ 403.22$ 3 Two Adults & Dependent Child(ren) 844.56$ 606.56$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 204.66$ 384.66$ 6 One Adult with Medicare, One person w/o Medicare 468.99$ 234.99$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 549.45$ 533.45$ 8 Two Adults with Medicare & Dependent Child(ren) 286.74$ 679.74$ 9 Adult & Dependent Child(ren) 422.55$ 302.55$

10 Adult with Medicare & Dependent Child(ren) 265.68$ 267.68$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 42 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 74% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 102 but less than 106 work days

PC Description @74% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 542.36$ 382.36$ 3 Two Adults & Dependent Child(ren) 813.28$ 575.28$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 197.08$ 377.08$ 6 One Adult with Medicare, One person w/o Medicare 451.62$ 217.62$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 529.10$ 513.10$ 8 Two Adults with Medicare & Dependent Child(ren) 276.12$ 669.12$ 9 Adult & Dependent Child(ren) 406.90$ 286.90$

10 Adult with Medicare & Dependent Child(ren) 255.84$ 257.84$ FIRE (Exceed 40hrs/wk)

@ 75% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 106 but less than 110 work days

PC Description @75% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 521.50$ 361.50$ 3 Two Adults & Dependent Child(ren) 782.00$ 544.00$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 189.50$ 369.50$ 6 One Adult with Medicare, One person w/o Medicare 434.25$ 200.25$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 508.75$ 492.75$ 8 Two Adults with Medicare & Dependent Child(ren) 265.50$ 658.50$ 9 Adult & Dependent Child(ren) 391.25$ 271.25$

10 Adult with Medicare & Dependent Child(ren) 246.00$ 248.00$ FIRE (Exceed 40hrs/wk)

@ 76% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 110 but less than 114 work days

PC Description @76% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 500.64$ 340.64$ 3 Two Adults & Dependent Child(ren) 750.72$ 512.72$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 181.92$ 361.92$ 6 One Adult with Medicare, One person w/o Medicare 416.88$ 182.88$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 488.40$ 472.40$ 8 Two Adults with Medicare & Dependent Child(ren) 254.88$ 647.88$ 9 Adult & Dependent Child(ren) 375.60$ 255.60$

10 Adult with Medicare & Dependent Child(ren) 236.16$ 238.16$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 43 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 77% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 114 but less than 118 work days

PC Description @77% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 479.78$ 319.78$ 3 Two Adults & Dependent Child(ren) 719.44$ 481.44$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 174.34$ 354.34$ 6 One Adult with Medicare, One person w/o Medicare 399.51$ 165.51$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 468.05$ 452.05$ 8 Two Adults with Medicare & Dependent Child(ren) 244.26$ 637.26$ 9 Adult & Dependent Child(ren) 359.95$ 239.95$

10 Adult with Medicare & Dependent Child(ren) 226.32$ 228.32$ FIRE (Exceed 40hrs/wk)

@ 78% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 118 but less than 122 work days

PC Description @78% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 458.92$ 298.92$ 3 Two Adults & Dependent Child(ren) 688.16$ 450.16$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 166.76$ 346.76$ 6 One Adult with Medicare, One person w/o Medicare 382.14$ 148.14$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 447.70$ 431.70$ 8 Two Adults with Medicare & Dependent Child(ren) 233.64$ 626.64$ 9 Adult & Dependent Child(ren) 344.30$ 224.30$

10 Adult with Medicare & Dependent Child(ren) 216.48$ 218.48$ FIRE (Exceed 40hrs/wk)

@ 79% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 122 but less than 126 work days

PC Description @79% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 438.06$ 278.06$ 3 Two Adults & Dependent Child(ren) 656.88$ 418.88$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 159.18$ 339.18$ 6 One Adult with Medicare, One person w/o Medicare 364.77$ 130.77$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 427.35$ 411.35$ 8 Two Adults with Medicare & Dependent Child(ren) 223.02$ 616.02$ 9 Adult & Dependent Child(ren) 328.65$ 208.65$

10 Adult with Medicare & Dependent Child(ren) 206.64$ 208.64$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 44 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 80% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 126 but less than 130 work days

PC Description @80% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 417.20$ 257.20$ 3 Two Adults & Dependent Child(ren) 625.60$ 387.60$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 151.60$ 331.60$ 6 One Adult with Medicare, One person w/o Medicare 347.40$ 113.40$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 407.00$ 391.00$ 8 Two Adults with Medicare & Dependent Child(ren) 212.40$ 605.40$ 9 Adult & Dependent Child(ren) 313.00$ 193.00$

10 Adult with Medicare & Dependent Child(ren) 196.80$ 198.80$ FIRE (Exceed 40hrs/wk)

@ 81% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 130 but less than 133 work days

PC Description @81% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 396.34$ 236.34$ 3 Two Adults & Dependent Child(ren) 594.32$ 356.32$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 144.02$ 324.02$ 6 One Adult with Medicare, One person w/o Medicare 330.03$ 96.03$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 386.65$ 370.65$ 8 Two Adults with Medicare & Dependent Child(ren) 201.78$ 594.78$ 9 Adult & Dependent Child(ren) 297.35$ 177.35$

10 Adult with Medicare & Dependent Child(ren) 186.96$ 188.96$ FIRE (Exceed 40hrs/wk)

@ 82% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 133 but less than 136 work days

PC Description @82% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 375.48$ 215.48$ 3 Two Adults & Dependent Child(ren) 563.04$ 325.04$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 136.44$ 316.44$ 6 One Adult with Medicare, One person w/o Medicare 312.66$ 78.66$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 366.30$ 350.30$ 8 Two Adults with Medicare & Dependent Child(ren) 191.16$ 584.16$ 9 Adult & Dependent Child(ren) 281.70$ 161.70$

10 Adult with Medicare & Dependent Child(ren) 177.12$ 179.12$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 45 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 83% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 136 but less than 139 work days

PC Description @83% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 354.62$ 194.62$ 3 Two Adults & Dependent Child(ren) 531.76$ 293.76$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 128.86$ 308.86$ 6 One Adult with Medicare, One person w/o Medicare 295.29$ 61.29$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 345.95$ 329.95$ 8 Two Adults with Medicare & Dependent Child(ren) 180.54$ 573.54$ 9 Adult & Dependent Child(ren) 266.05$ 146.05$

10 Adult with Medicare & Dependent Child(ren) 167.28$ 169.28$ FIRE (Exceed 40hrs/wk)

@ 84% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 139 but less than 142 work days

PC Description @84% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 333.76$ 173.76$ 3 Two Adults & Dependent Child(ren) 500.48$ 262.48$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 121.28$ 301.28$ 6 One Adult with Medicare, One person w/o Medicare 277.92$ 43.92$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 325.60$ 309.60$ 8 Two Adults with Medicare & Dependent Child(ren) 169.92$ 562.92$ 9 Adult & Dependent Child(ren) 250.40$ 130.40$

10 Adult with Medicare & Dependent Child(ren) 157.44$ 159.44$ FIRE (Exceed 40hrs/wk)

@ 85% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 142 but less than 145 work days

PC Description @85% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 312.90$ 152.90$ 3 Two Adults & Dependent Child(ren) 469.20$ 231.20$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 113.70$ 293.70$ 6 One Adult with Medicare, One person w/o Medicare 260.55$ 26.55$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 305.25$ 289.25$ 8 Two Adults with Medicare & Dependent Child(ren) 159.30$ 552.30$ 9 Adult & Dependent Child(ren) 234.75$ 114.75$

10 Adult with Medicare & Dependent Child(ren) 147.60$ 149.60$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 46 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 86% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 145 but less than 148 work days

PC Description @86% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 292.04$ 132.04$ 3 Two Adults & Dependent Child(ren) 437.92$ 199.92$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 106.12$ 286.12$ 6 One Adult with Medicare, One person w/o Medicare 243.18$ 9.18$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 284.90$ 268.90$ 8 Two Adults with Medicare & Dependent Child(ren) 148.68$ 541.68$ 9 Adult & Dependent Child(ren) 219.10$ 99.10$

10 Adult with Medicare & Dependent Child(ren) 137.76$ 139.76$ FIRE (Exceed 40hrs/wk)

@ 87% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 148 but less than 151 work days

PC Description @87% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 271.18$ 111.18$ 3 Two Adults & Dependent Child(ren) 406.64$ 168.64$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 98.54$ 278.54$ 6 One Adult with Medicare, One person w/o Medicare 225.81$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 264.55$ 248.55$ 8 Two Adults with Medicare & Dependent Child(ren) 138.06$ 531.06$ 9 Adult & Dependent Child(ren) 203.45$ 83.45$

10 Adult with Medicare & Dependent Child(ren) 127.92$ 129.92$ FIRE (Exceed 40hrs/wk)

@ 88% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 151 but less than 154 work days

PC Description @88% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 250.32$ 90.32$ 3 Two Adults & Dependent Child(ren) 375.36$ 137.36$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 90.96$ 270.96$ 6 One Adult with Medicare, One person w/o Medicare 208.44$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 244.20$ 228.20$ 8 Two Adults with Medicare & Dependent Child(ren) 127.44$ 520.44$ 9 Adult & Dependent Child(ren) 187.80$ 67.80$

10 Adult with Medicare & Dependent Child(ren) 118.08$ 120.08$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 47 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 89% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 154 but less than 157 work days

PC Description @89% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 229.46$ 69.46$ 3 Two Adults & Dependent Child(ren) 344.08$ 106.08$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 83.38$ 263.38$ 6 One Adult with Medicare, One person w/o Medicare 191.07$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 223.85$ 207.85$ 8 Two Adults with Medicare & Dependent Child(ren) 116.82$ 509.82$ 9 Adult & Dependent Child(ren) 172.15$ 52.15$

10 Adult with Medicare & Dependent Child(ren) 108.24$ 110.24$ FIRE (Exceed 40hrs/wk)

@ 90% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 157 but less than 160 work days

PC Description @90% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 208.60$ 48.60$ 3 Two Adults & Dependent Child(ren) 312.80$ 74.80$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 75.80$ 255.80$ 6 One Adult with Medicare, One person w/o Medicare 173.70$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 203.50$ 187.50$ 8 Two Adults with Medicare & Dependent Child(ren) 106.20$ 499.20$ 9 Adult & Dependent Child(ren) 156.50$ 36.50$

10 Adult with Medicare & Dependent Child(ren) 98.40$ 100.40$ FIRE (Exceed 40hrs/wk)

@ 91% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 160 but less than 163 work days

PC Description @91% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 187.74$ 27.74$ 3 Two Adults & Dependent Child(ren) 281.52$ 43.52$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 68.22$ 248.22$ 6 One Adult with Medicare, One person w/o Medicare 156.33$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 183.15$ 167.15$ 8 Two Adults with Medicare & Dependent Child(ren) 95.58$ 488.58$ 9 Adult & Dependent Child(ren) 140.85$ 20.85$

10 Adult with Medicare & Dependent Child(ren) 88.56$ 90.56$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 48 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 92% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 163 but less than 166 work days

PC Description @92% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 166.88$ 6.88$ 3 Two Adults & Dependent Child(ren) 250.24$ 12.24$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 60.64$ 240.64$ 6 One Adult with Medicare, One person w/o Medicare 138.96$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 162.80$ 146.80$ 8 Two Adults with Medicare & Dependent Child(ren) 84.96$ 477.96$ 9 Adult & Dependent Child(ren) 125.20$ 5.20$

10 Adult with Medicare & Dependent Child(ren) 78.72$ 80.72$ FIRE (Exceed 40hrs/wk)

@ 93% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 166 but less than 169 work days

PC Description @93% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 146.02$ -$ 3 Two Adults & Dependent Child(ren) 218.96$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 53.06$ 233.06$ 6 One Adult with Medicare, One person w/o Medicare 121.59$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 142.45$ 126.45$ 8 Two Adults with Medicare & Dependent Child(ren) 74.34$ 467.34$ 9 Adult & Dependent Child(ren) 109.55$ -$

10 Adult with Medicare & Dependent Child(ren) 68.88$ 70.88$ FIRE (Exceed 40hrs/wk)

@ 94% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 169 but less than 172 work days

PC Description @94% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 125.16$ -$ 3 Two Adults & Dependent Child(ren) 187.68$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 45.48$ 225.48$ 6 One Adult with Medicare, One person w/o Medicare 104.22$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 122.10$ 106.10$ 8 Two Adults with Medicare & Dependent Child(ren) 63.72$ 456.72$ 9 Adult & Dependent Child(ren) 93.90$ -$

10 Adult with Medicare & Dependent Child(ren) 59.04$ 61.04$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 49 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 95% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 172 but less than 175 work days

PC Description @95% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 104.30$ -$ 3 Two Adults & Dependent Child(ren) 156.40$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 37.90$ 217.90$ 6 One Adult with Medicare, One person w/o Medicare 86.85$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 101.75$ 85.75$ 8 Two Adults with Medicare & Dependent Child(ren) 53.10$ 446.10$ 9 Adult & Dependent Child(ren) 78.25$ -$

10 Adult with Medicare & Dependent Child(ren) 49.20$ 51.20$ FIRE (Exceed 40hrs/wk)

@ 96% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 175 but less than 178 work days

PC Description @96% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 83.44$ -$ 3 Two Adults & Dependent Child(ren) 125.12$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 30.32$ 210.32$ 6 One Adult with Medicare, One person w/o Medicare 69.48$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 81.40$ 65.40$ 8 Two Adults with Medicare & Dependent Child(ren) 42.48$ 435.48$ 9 Adult & Dependent Child(ren) 62.60$ -$

10 Adult with Medicare & Dependent Child(ren) 39.36$ 41.36$ FIRE (Exceed 40hrs/wk)

@ 97% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 178 but less than 181 work days

PC Description @97% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 62.58$ -$ 3 Two Adults & Dependent Child(ren) 93.84$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 22.74$ 202.74$ 6 One Adult with Medicare, One person w/o Medicare 52.11$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 61.05$ 45.05$ 8 Two Adults with Medicare & Dependent Child(ren) 31.86$ 424.86$ 9 Adult & Dependent Child(ren) 46.95$ -$

10 Adult with Medicare & Dependent Child(ren) 29.52$ 31.52$

10/5/2017 2017 FIRE CONTRIBUTION RATE MATRIX THRU AGE 60 (Exceed 40hrs/wk)

RATES/WEBSITE 2018 RETIREE RATE CHARTS 50 of 51Department of Employee Relations

City Hall, Room 706

FIRE (Exceed 40hrs/wk)

@ 98% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 181 but less than 184 work days

PC Description @98% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 41.72$ -$ 3 Two Adults & Dependent Child(ren) 62.56$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 15.16$ 195.16$ 6 One Adult with Medicare, One person w/o Medicare 34.74$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 40.70$ 24.70$ 8 Two Adults with Medicare & Dependent Child(ren) 21.24$ 414.24$ 9 Adult & Dependent Child(ren) 31.30$ -$

10 Adult with Medicare & Dependent Child(ren) 19.68$ 21.68$ FIRE (Exceed 40hrs/wk)

@ 99% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 184 but less than 187 work days

PC Description @99% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare 20.86$ -$ 3 Two Adults & Dependent Child(ren) 31.28$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare 7.58$ 187.58$ 6 One Adult with Medicare, One person w/o Medicare 17.37$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) 20.35$ 4.35$ 8 Two Adults with Medicare & Dependent Child(ren) 10.62$ 403.62$ 9 Adult & Dependent Child(ren) 15.65$ -$

10 Adult with Medicare & Dependent Child(ren) 9.84$ 11.84$ FIRE (Exceed 40hrs/wk)

@ 100% City Contribution FIRE (Exceed 40hrs/wk) - Unused S/L - At

least 187 work days

PC Description @100% UHC CHOICE PLUS UHC CHOICE1 One Adult w/o Medicare -$ -$ 2 Two Adults w/o Medicare -$ -$ 3 Two Adults & Dependent Child(ren) -$ -$ 4 One Adult with Medicare -$ -$ 5 Two Adults with Medicare -$ 180.00$ 6 One Adult with Medicare, One person w/o Medicare -$ -$ 7 One Adult with Medicare, One person w/o Medicare & Dependent Child(ren) -$ -$ 8 Two Adults with Medicare & Dependent Child(ren) -$ 393.00$ 9 Adult & Dependent Child(ren) -$ -$

10 Adult with Medicare & Dependent Child(ren) -$ 2.00$

10/5/2017

DENTAL PLAN SINGLE PREMIUM

FAMILY PREMIUM

Delta PPO 24.77$ 85.59$

Delta EPO 44.17$ 144.30$

Care Plus 52.62$ 155.07$

FireDelta PPO 29.72$ 85.12$

PoliceDelta PPO 29.81$ 90.67$

2% COBRA Rate NOT included in these rates.2018 DENTAL PLAN RATES