Att D5 - 2021 Final Dental and Health Premiums.pdf
PDF 118 KB Posted
- Attached to
- RFP #2021-03 Health and Wellness Services
- Solicitation number
- 2021 - 03
- Issued by
- Wisconsin
About this file
This document is a 2021 Benefits Premiums schedule for the County of Dunn, detailing health insurance coverage options and associated costs for employees. The file outlines multiple health insurance plan options available to county employees, including CompleteHealth and Choice Passport plans across various deductible levels ($3,000, $5,000, $6,000, and $10,000). Coverage categories include standard employees, union public safety employees, and part-time or retired/resigned participants, with both single and family plan options. All plans listed are HSA-eligible, indicating compliance with Health Savings Account requirements. The document does not specify contract term dates, renewal options, bidder meetings, or award dates, as it functions as a benefits premium reference schedule rather than a solicitation document.
The premium structure divides costs between employee and county contributions, with total monthly premiums ranging from $889.52 to $2,649.18 depending on plan type and coverage level. Union public safety employees receive preferential pricing on certain plans, particularly Choice Passport family coverage options. Part-time and retired/resigned participants are offered simplified single and family plan rates at $982.14 and $2,649.18, respectively, without deductible variations. The document indicates the county funds a substantial portion of premiums across all plan types, with county contributions ranging from approximately 78 to 96 percent of total monthly costs. The schedule does not identify incumbent carriers, funding sources, or set-asides, appearing to serve as an internal benefits administration document establishing premium rates for the 2021 benefit year.
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Text version
2021 Benefits Premiums
Health Insurance Coverage Type Employee Contribution
County Contribution
Total Premium
HSA Eligible $3,000 Deductible CompleteHealth (Single)
$78.58 $903.56 $982.14
HSA Eligible $6,000 Deductible CompleteHealth (Family)
$158.96 $2,490.22 $2,649.18
HSA Eligible $3,000 Deductible Choice Passport (Single)
$127.68 $854.46 $982.14
HSA Eligible $6,000 Deductible Choice Passport (Family)
$264.92 $2,384.26 $2,649.18
Union Public Safety Employees Only
HSA Eligible $3,000 Deductible CompleteHealth (Single)
$78.58 $903.56 $982.14
Union Public Safety Employees Only
HSA Eligible $6,000 Deductible
CompleteHealth (Family)
$158.96 $2,490.22 $2,649.18
Union Public Safety Employees Only
HSA Eligible $3,000 Deductible Choice Passport (Single)
$78.58 $903.56 $982.14
Union Public Safety Employees Only
HSA Eligible $6,000 Deductible Choice Passport (Family)
$211.93 $2437.24 $2,649.18
Part Time AND Retired/Resigned Participants
Single Plan $982.14
Family Pan $2,649.18
HSA Eligible $5,000 Deductible CompleteHealth (Single)
$44.48 $845.04 $889.52
HSA Eligible $10,000 Deductible CompleteHealth (Family)
$96.02 $2,304.40 $2,400.42
HSA Eligible $5,000 Deductible Choice Passport (Single)
$106.74 $782.78 $889.52
HSA Eligible $10,000 Deductible Choice Passport (Family)
$144.02 $2,256.40 $2,400.42
Union Public Safety Employees Only
HSA Eligible $5,000 Deductible CompleteHealth (Single)
$44.48 $845.04 $889.52
Union Public Safety Employees Only
HSA Eligible $10,000 Deductible
CompleteHealth (Family)
$96.02 $2,304.40 $2,400.42
Union Public Safety Employees Only
HSA Eligible $5,000 Deductible Choice Passport (Single)
$71.16 $818.36 $889.52
Union Public Safety Employees Only
HSA Eligible $5,000 Deductible Choice Passport (Family)
$192.04 $2,208.38 $2,400.42
C o u n ty o f D u n
2021 Benefits Premiums
Critical Illness Coverage Amount
Monthly Attained Age Premiums
Age Band
<30 30-39 40-49 50-59 60-70
$5,000 $1.60 $2.60 $5.55 $11.45 $21.65
$10,000 $3.20 $5.20 $11.10 $22.90 $43.30
$15,000 $4.80 $7.80 $16.65 $34.35 $64.95
$20,000 $6.40 $10.40 $22.20 $45.80 $86.60
$25,000 $8.00 $13.00 $27.75 $57.25 $108.25
$30,000 $9.60 $15.60 $33.30 $68.70 $129.90
$35,000 $11.20 $18.20 $38.85 $80.15 $151.55
$40,000 $12.80 $20.80 $44.40 $91.60 $173.20
$45,000 $14.40 $23.40 $49.95 $103.05 $194.85
$50,000 $16.00 $26.00 $55.50 $114.50 $216.50
Part Time AND Retired/Resigned
Single Plan $889.52
Family Plan $2,400.42
Dental Insurance Coverage Type
Employee Contribution
County Contribution
Total Premium
DentaCare $91.91 $50 $141.91
Freestanding $63.87 $50 $113.87
Part Time AND Retired/Resigned
DentaCare $141.91
Freestanding $113.87
Accident Insurance Coverage Type
Employee Contribution
(Non-Management)
Employee Contribution
(Management)
Employee $7.39 $0.00
Employee + Spouse $10.67 $3.28
Employee + Children $13.05 $5.66
Employee + Spouse + Children $19.93 $12.54
C o u n ty o f D u
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