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1

$

19.34

$

247.20

$

133.27

$

133.27

2

$

38.68

$

494.40

$

266.54

$

266.54

3

$

34.04

$

435.07

$

234.55

$

234.55

4

$

53.38

$

682.27

$

367.82

$

367.82

1

$

19.10

$

247.20

$

133.15

$

133.15

2

$

38.20

$

494.40

$

266.30

$

266.30

3

$

33.62

$

435.07

$

234.34

$

234.34

4

$

52.72

$

682.27

$

367.49

$

367.49

1

$

26.80

$

247.20

$

137.00

$

137.00

2

$

53.61

$

494.40

$

274.00

$

274.00

3

$

47.18

$

435.07

$

241.12

$

241.12

4

$

73.98

$

682.27

$

378.12

$

378.12

1

$

15.67

$

247.20

$

131.44

$

131.44

2

$

31.35

$

494.40

$

262.87

$

262.87

3

$

27.59

$

435.07

$

231.33

$

231.33

4

$

43.26

$

682.27

$

362.77

$

362.77

1

$

12.63

$

240.03

$

126.33

$

126.33

2

$

25.27

$

480.05

$

252.66

$

252.66

3

$

22.23

$

422.45

$

222.34

$

222.34

4

$

34.87

$

662.48

$

348.67

$

348.67

1

$

12.07

$

229.24

$

120.65

$

120.65

2

$

24.23

$

460.45

$

242.34

$

242.34

3

$

21.31

$

404.96

$

213.14

$

213.14

4

$

33.48

$

636.17

$

334.83

$

334.83

1

$

12.79

$

242.95

$

127.87

$

127.87

2

$

25.57

$

485.89

$

255.73

$

255.73

3

$

22.50

$

427.58

$

225.04

$

225.04

4

$

35.29

$

670.53

$

352.91

$

352.91

1 2

$ $

0 0

$ $

15.81 31.62

$ $

7.91 15.81

$ $

7.91 15.81

3 4

$ $

0 0

$ $

31.62 31.62

$ $

15.81 15.81

$ $

15.81 15.81

(n/a)

(n/a)

(n/a)

(n/a)

(n/a)

13

Blue Care Network, Great Lakes West

Blue Care Network, Southeast Michigan

Grand Valley Health Plan

Health Alliance Plan

HealthPlus of Michigan

1

2

3

Part-time employees hired after 1/1/2000 (1/1/2002 for MSEA represented bargaining units A02 and A31) 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.

Civil Service Commission, Employee Benefits Division

Decline Health Insurance Coverage Blue Care Network, Mid-Michigan

Blue Care Network, East Michigan

3

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

Employees in the Catastrophic Health Plan will receive a $50 rebate with each paycheck beginning October 13, 2011.

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

1

$

27.47

$

247.20

$

137.33

$

137.33

2

$

54.93

$

494.40

$

274.66

$

274.66

3

$

48.34

$

435.07

$

241.71

$

241.71

4

$

75.81

$

682.27

$

379.04

$

379.04

For Bargaining Units: MSEA (A02, A31), MCO (C12), AFSCME (U11) 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.

State Health Plan PPO

PLAN NAME/CODE

2 Option

Employee

State

Employee

State

(a)

(b)

(c)

(d)

(e)

HEALTH PLANS

BIWEEKLY

BIWEEKLY Part-time employees 1

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