Pompton Lakes Board of Education Annual Health Plan Negotiated Employee Contribution Comparison Single Coverage - July 2018 through June 2019

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1 Single Coverage - July 2018 through June 2019 Annual Single Coverage Negotiated Contribution Step 2: Identify the below medical plan in Range that matches your chosen plan of benefits; add the prescription and dental s. less than 45, % $ $ $ $ $ ,000-50, % $ $ $ $ $ ,000-59, % $1, $ $ $ $ ,000-64, % $1, $1, $ $ $ , % $1, $1, $1, $ $ ,000-83, % $2, $2, $1, $ $ ,000-91, % $2, $2, $1, $ $ , , % $2, $2, $1, $ $ ,000 and over 28.00% $2, $2, $2, $ $ Monthly Single Premium $ $ $ $ $54.66 for your : To calculate your approximate per paycheck: 1) if you are a 10-month employee, divide the shown matching your salary range by 20. 2) if you are a 12-month employee, divide the shown matching your salary range by 24.

2 Parent-Child Coverage - July 2018 through June 2019 Annual Parent-Child Coverage Negotiated Contribution Step 2: Identify the below medical plan in Range that matches your chosen plan of benefits; add the prescription and dental s less than 45, % $ $ $ $ $ ,000-50, % $1, $1, $1, $ $ ,000-59, % $1, $1, $1, $ $ ,000-64, % $2, $2, $1, $ $ , % $2, $2, $2, $ $ ,000-83, % $3, $3, $2, $1, $ ,000-91, % $4, $3, $3, $1, $ , , % $4, $4, $3, $1, $ ,000 and over 28.00% $4, $4, $3, $1, $ Monthly P-Child Premium $1, $1, $1, $ $ for your : To calculate your approximate per paycheck: 1) if you are a 10-month employee, divide the shown matching your salary range by 20. 2) if you are a 12-month employee, divide the shown matching your salary range by 24.

3 Parent-Children Coverage - July 2018 through June 2019 Annual Parent-Children Coverage Negotiated Contribution Step 2: Identify the below medical plan in Range that matches your chosen plan of benefits; add the prescription and dental s less than 45, % $ $ $ $ $ ,000-50, % $1, $1, $1, $ $ ,000-59, % $1, $1, $1, $ $ ,000-64, % $2, $2, $1, $ $ , % $2, $2, $2, $1, $ ,000-83, % $3, $3, $2, $1, $ ,000-91, % $4, $3, $3, $1, $ , , % $4, $4, $3, $1, $ ,000 and over 28.00% $4, $4, $3, $2, $ Monthly P-Children Premium $1, $1, $1, $ $ for your : To calculate your approximate per paycheck: 1) if you are a 10-month employee, divide the shown matching your salary range by 20. 2) if you are a 12-month employee, divide the shown matching your salary range by 24.

4 2Adult Coverage - July 2018 through June 2019 Annual 2Adult Coverage Negotiated Contribution Step 2: Identify the below medical plan in Range that matches your chosen plan of benefits; add the prescription and dental s. less than 45, % $1, $ $ $ $ ,000-50, % $1, $1, $1, $ $ ,000-59, % $2, $1, $1, $ $ ,000-64, % $2, $2, $1, $ $ , % $3, $3, $2, $1, $ ,000-83, % $4, $4, $3, $1, $ ,000-91, % $4, $4, $3, $1, $ , , % $5, $4, $3, $1, $ ,000 and over 28.00% $5, $5, $4, $1, $ Monthly 2AD Premium $1, $1, $1, $ $ for your : To calculate your approximate per paycheck: 1) if you are a 10-month employee, divide the shown matching your salary range by 20. 2) if you are a 12-month employee, divide the shown matching your salary range by 24.

5 Family Coverage - July 2018 through June 2019 Annual Family Coverage Negotiated Contribution Step 2: Identify the below medical plan in Range that matches your chosen plan of benefits; add the prescription and dental s. less than 45, % $1, $1, $1, $ $ ,000-50, % $2, $1, $1, $ $ ,000-59, % $2, $2, $2, $ $ ,000-64, % $3, $3, $2, $ $ , % $4, $4, $3, $1, $ ,000-83, % $6, $5, $4, $1, $ ,000-91, % $6, $5, $4, $1, $ , , % $7, $6, $5, $1, $ ,000 and over 28.00% $7, $6, $5, $2, $ Monthly Family Premium $2, $2, $1, $ $ for your : To calculate your approximate per paycheck: 1) if you are a 10-month employee, divide the shown matching your salary range by 20. 2) if you are a 12-month employee, divide the shown matching your salary range by 24.