New Management/Confidential Health Insurance Payroll Biweekly Deductions

Effective October 1, 2011

Insurance Plan Options Annual Salary
Below $41,537
(A)
Above $41,537
(B)
Empire Plan Individual $32.09 $42.79
Family $128.08 $153.00
AETNA - HMO Individual $109.56 $119.92
Family $465.59 $490.22
HIP - HMO Individual $54.94 $65.26
Family $185.34 $210.40
Empire Blue Cross Blue Shield HMO Individual $132.00 $142.56
Family $425.05 $451.09
Empire Plan Deductible $388.00 $388.00
Empire Plan Out of Pocket Maximum $1,069.00 $1,069.00

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