MANHATTAN BEACH UNIFIED SCHOOL DISTRICT Insurance Rates

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1 Insurance Rates Total Premium District Share Full Time Employee Share Anthem Blue Cross Premier Select HMO Single $ $ $ Party $ 1, $ 1, $ Family $ 2, $ 1, $ Anthem Blue Cross Premier Vivity HMO Single $ $ $ Party $ 1, $ 1, $ Family $ 2, $ 1, $ Anthem Blue Cross Custom Premier PPO Single $ 1, $ $ Party $ 2, $ 1, $ 1, Family $ 3, $ 1, $ 2, Anthem Blue Cross Custom Classic PPO Single $ 1, $ $ Party $ 2, $ 1, $ 1, Family $ 3, $ 1, $ 1, Kaiser Permanente HMO ($0 Copay Option) Single $ $ $ Party $ 1, $ 1, $ Family $ 1, $ 1, $ Kaiser Permanente HMO ($15 Copay Option) Single $ $ $ Party $ 1, $ 1, $ Family $ 1, $ 1, $ Delta Dental Plan Single $ $ $ Party $ $ $ Family $ $ $ Vision Service Plan Single $ $ 9.57 $ Party $ $ $ 4.78 Family $ $ $ 7.70 DISTRICT PAID - must work minimum 50% time DISTRICT PAID - must work minimum 50% time Printed: 7/19/2017-2:37 PM

2 Employee's share is based on 50% time pay Employee Contribution per MONTH Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 7/20/2017 individual % rate charts / 50%-mo

3 Employee's share is based on 60% time. Employee Contribution per MONTH Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 8/3/16 individual % rate charts / 60% mo

4 Employee's share is based on 75% time (6 hrs). Employee Contribution per MONTH Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 7/20/17 individual % rate charts / 75-mo

5 Employee's share is based on 80% time pay Employee Contribution per MONTH Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 7/20/2017 individual % rate charts / 80% monthly

6 Employee's share is based on % time (3.25 hrs). The Annual premium is divided by nineteen to get a per paycheck amount. The first deduction will come from your paycheck issued September 25th. Employee Contribution per PAYCHECK Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 7/20/17 individual % rate charts /

7 Employee's share is based on 50% time (4 hrs). The Annual premium is divided by nineteen to get a per paycheck amount. The first deduction will come from your paycheck issued September 25th. Employee Contribution per PAYCHECK Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 7/20/2017 individual % rate charts / 50%-19

8 Employee's share is based on 75% time (6 hrs). The Annual premium is divided by nineteen to get a per paycheck amount. The first deduction will come from your paycheck issued September 25th. Employee Contribution per PAYCHECK Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 7/11/16 individual % rate charts / 75-19

9 Employee's share is based on 81.25% time (6.5 hrs). The Annual premium is divided by nineteen to get a per paycheck amount. The first deduction will come from your paycheck issued September 25th. Employee Contribution per PAYCHECK Anthem BCP Select HMO Anthem BCP Vivity HMO Anthem BCC Premier PPO Anthem BCC Classic PPO Kaiser HMO ($0 Copay) Kaiser HMO ($15 Copay) DELTA DENTAL PLAN VISION SERVICE PLAN revised 7/20/17 individual % rate charts /

Anthem Blue Cross. Introduction 1. Verifying Member Eligibility and Benefits 1. Sample Anthem Blue Cross Member ID Card 2

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