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<br />. <br /> <br />APR-29-21302 10' 04 <br /> <br />Medical Coverstn - HMO <br /> <br />Preferred One $10/1 00'10 <br />Sinsle <br />Family <br /> <br />HealthPanners S I 011 00% <br />Single . <br />Famlly <br /> <br />Basic Life! ADA)} InsuNe.. <br /> <br />Basic LlfWAD&D: <br /> <br />Dependent Life: <br /> <br />Supplemental Life!AD&D: <br />(per ThoUSlllld) <br /> <br />Dental Cove~e- <br /> <br />Preventive Dental: <br /> <br />Employee: <br />Family: <br /> <br />Comprehensive Dental: <br /> <br />Employ....: <br />FlIIllily: <br /> <br />Mars~ Advantage America <br /> <br />EXIDBlT B <br />City of CmtervllIe <br />6I1/1n lUnewullUleI <br />$10/100"1. HMO MaIlllIle4 Care Plan <br /> <br />Current Rates <br /> <br />$253.58 <br />$612.38 <br /> <br />$241.50 <br />$572.31 <br /> <br />$ .18/1,000 <br />$J.18lUnit <br /> <br />All. <br /><35 <br />35-39 <br />40-44 <br />45-49 <br />SO-54 <br />55-59 <br />60-64 <br />65-69 <br /> <br />Monthly Rate: <br />If Emptoyer Pays <br />ooeA or More of Cost <br />$ 8.02 <br />$24.24 <br /> <br />Monthly Rate <br />If Employer Pays <br />90% or More of Cost <br />$27.41 <br />$65.30 <br /> <br />9528263840 P. 05/05 <br /> <br />Renewal Rates <br /> <br />5303.03 <br />$731.79 <br /> <br />$288.59 <br />$683.91 <br />. <br /> <br />$ .22/1,000 . <br /> <br />S1.181Unit <br /> <br />.10 <br />.12 <br />.18 <br />.27 <br />.46 <br />.74 <br />.82 <br />1.56 <br /> <br />Monthly Rate <br />If Employer Pays <br />50-89".4 of Cost <br />$ 8.74 <br />$26.86 <br /> <br />Monthly Rate <br />If Employer Pays <br />50.89% of Cost <br />$30.25 <br />$71.63 <br /> <br />TOTAL P. 05 <br />