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1

$

19.44

$

248.44

$

133.94

$

133.94

2

$

38.88

$

496.87

$

267.87

$

267.87

3

$

34.21

$

437.25

$

235.73

$

235.73

4

$

53.64

$

685.68

$

369.66

$

369.66

1

$

19.19

$

248.44

$

133.81

$

133.81

2

$

38.39

$

496.87

$

267.63

$

267.63

3

$

33.79

$

437.25

$

235.52

$

235.52

4

$

52.98

$

685.68

$

369.33

$

369.33

1

$

26.94

$

248.44

$

137.69

$

137.69

2

$

53.88

$

496.87

$

275.37

$

275.37

3

$

47.41

$

437.25

$

242.33

$

242.33

4

$

74.35

$

685.68

$

380.01

$

380.01

1

$

15.75

$

248.44

$

132.09

$

132.09

2

$

31.51

$

496.87

$

264.19

$

264.19

3

$

27.73

$

437.25

$

232.49

$

232.49

4

$

43.48

$

685.68

$

364.58

$

364.58

1

$

12.81

$

243.37

$

128.09

$

128.09

2

$

25.62

$

486.75

$

256.18

$

256.18

3

$

22.54

$

428.34

$

225.44

$

225.44

4

$

35.35

$

671.71

$

353.53

$

353.53

1

$

12.12

$

230.34

$

121.23

$

121.23

2

$

24.35

$

462.66

$

243.50

$

243.50

3

$

21.42

$

406.91

$

214.16

$

214.16

4

$

33.64

$

639.22

$

336.43

$

336.43

1

$

12.85

$

244.16

$

128.51

$

128.51

2

$

25.70

$

488.32

$

257.01

$

257.01

3

$

22.62

$

429.72

$

226.17

$

226.17

4

$

35.47

$ 673.88

$

354.68

$

354.68

Health Alliance Plan

HealthPlus of Michigan This HMO is not authorized to accept employees in bargaining

units W22 and W41 (UAW) in some zip codes as new members.

Grand Valley Health Plan

This HMO is not authorized to accept employees in bargaining units W22 and W41 (UAW) as new members. However,

employees who are already enrolled may remain enrolled.

1

2 3

Part-time employees hired after 1/1/2000 whose regular work schedule is 40 hours or less per biweekly pay period pay premiums according to column (d). Health option codes are: 1 = Employee only coverage, 2 = Employee & Spouse, 3 = Employee & Child(ren), 4 = Full Family. Employees who opt out of health coverage (because they have “primary” coverage through a non-State employee or non-State retired spouse) will receive a rebate identical to the Catastrophic Health Plan.

11

Blue Care Network, Southeast Michigan

Blue Care Network, Great Lakes West

Blue Care Network, East Michigan

Civil Service Commission, Employee Benefits Division

FY 2011-2012 GROUP INSURANCE PREMIUM RATES FOR EMPLOYEES HIRED PRIOR TO APRIL 1, 2010, EFFECTIVE OCTOBER 2, 2011

For Bargaining Units: NERE, UAW (W22, W41), SEIU 517M (E42, H21, L32)

Note: When choosing an HMO plan, be sure to review HMO availability in your area. The HMO Postal Code List is on the Employee Benefits Website at www.michigan.gov/employeebenefits. Click Open Enrollment Information.

PLAN NAME/CODE

State Health Plan PPO

Employee or Spouse with Medicare (State pays 100%) Catastrophic Health Plan

Employees in the Catastrophic Health Plan will receive a$50 rebate with each paycheck beginning

1

$

27.60

$

248.44

$

138.02

$

138.02

2

$

55.21

$

496.87

$

276.04

$

276.04

3

$

48.58

$

437.25

$

242.91

$

242.91

4

$

76.19

$

685.68

$

380.93

$

380.93

October 13, 2011. Decline Health Insurance Coverage Blue Care Network, Mid-Michigan

3

1

$

0

$

15.81

$

7.91

$

7.91

2

$

0

$

31.62

$

15.81

$

15.81

3

$

0

$

31.62

$

15.81

$

15.81

4

$

0

$

31.62

$

15.81

$

15.81

(n/a)

(n/a)

(n/a)

(n/a)

(n/a)

1 BIWEEKLY Part-time employees

Employee

State

(d)

(e)

BIWEEKLY

State (c)

Option

2

(a) HEALTH PLANS

Employee (b)

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