Open Enrollment Active Employees

Comparing Your 2012 and 2013 Group Insurance Rates For Active Employees

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Instructions 1. Enter the required information (A through E) below. 2. Enter all of your current 2012 plans (displayed on your pay slip) in the "Current 2012 Election" column. 3. Enter all of the plans you are thinking about electing for 2013 in the "Possible 2013 Election" column. 4. Click the Calculate button.

A. Is your original date of hire on or after 10/01/1994? Yes No B. What is your annual salary? $ per year C. Is your position represented by a bargaining unit? Yes No D. Please select one: Fire Bargaining Unit (IAFF) Police Bargaining Unit (FOP) Office, Professional and Technical (OPT) Service Labor Trade (SLT) Non-Represented E. Your age: 24 or Younger 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69

Type Plan Option Pay Slip Code Current 2012 Election Possible 2013 Election Medical CareFirst BCBS Point of Service High Option BCBS HI None   Self   Self+1   Family       None   Self   Self+1   Family       CareFirst BCBS Point of Service Standard Option BCBS STD None   Self   Self+1   Family       None   Self   Self+1   Family       United Healthcare UH HMO None   Self   Self+1   Family       None   Self   Self+1   Family       Kaiser Permanente (Includes Kaiser Rx coverage) Kaiser None   Self   Self+1   Family       None   Self   Self+1   Family       Prescription Caremark High Option RX 4_8 * RX 4_8 None   Self   Self+1   Family       None   Self   Self+1   Family       Caremark High Option RX 5_10 ** RX 5_10 None   Self   Self+1   Family       None   Self   Self+1   Family       Caremark Standard Option RX STD None   Self   Self+1   Family       None   Self   Self+1   Family       Dental United Concordia Dental PPO (Traditional Plan) UC PPO None   Self   Self+1   Family       None   Self   Self+1   Family       United Concordia Dental HMO (DHMO) UC DMO None   Self   Self+1   Family       None   Self   Self+1   Family       Vision NVA Vision Plan Vision None   Self   Self+1   Family       None   Self   Self+1   Family       Life Insurance Employee Optional Life *** Optional Life None 1x Salary 2x Salary 3x Salary 4x Salary   None 1x Salary 2x Salary 3x Salary 4x Salary   Dependent Life **** Dep Life None Level 1 Level 2 Level 3       None Level 1 Level 2 Level 3       *  IAFF/MCGEO **  FOP/Unrepresented ***  The maximum coverage amount is $400,000. ****  Level 1: $2,000–spouse, $1,000–child 6 months to 21 yrs, $100–child under 6 months Level 2: $4,000–spouse, $2,000–child 6 months to 21 yrs, $100–child under 6 months Level 3: $10,000–spouse, $5,000–child 6 months to 21 yrs, $100–child under 6 months

This tool helps you estimate the difference you would pay based on the group insurance plans you elect for 2013 compared to 2012. Please note that you cannot elect your 2013 plans or change plans through the use of this tool. Also, this estimator does not include any Flexible Spending Account (FSA) amount you elect. (Note: FSA biweekly amounts can be determined by dividing the annual amount you elect by 26 pay periods. The minimum FSA election is $100 annually; $3.84 per day.) If you cover a domestic partner and/or a domestic partner's child, the rates displayed do not include imputed income. This estimator applies to active, full-time employees. It does not apply to employees who are part-time, temporary or retired. It also does not apply to employees of municipalities or participating agencies.