Att D5 - 2021 Final Dental and Health Premiums.pdf

118 KB Posted

Attached to
RFP #2021-04 Dental Services
Solicitation number
2021 - 04
Issued by
Wisconsin

About this file

Written by GovTribe AI ·

This document is a 2021 benefits premium schedule for Dunn County, Wisconsin, detailing health insurance coverage options and associated costs for employees and their families. The file presents premium structures for multiple health insurance plans, including CompleteHealth and Choice Passport options, with varying deductible levels ($3,000, $5,000, $6,000, and $10,000) designated as HSA-eligible. The schedule segments employees into distinct categories: standard employees, Union Public Safety Employees, and Part Time/Retired/Resigned Participants, with each category receiving differentiated premium rates. Coverage types include both single and family plan options across the identified insurance products.

The premium structure reflects a cost-sharing model between employees and Dunn County, with total monthly premiums ranging from $889.52 to $2,649.18 depending on plan selection and coverage tier. For example, a standard employee selecting the HSA-eligible $3,000 deductible CompleteHealth single plan pays $78.58 monthly with the county contributing $903.56 for a total premium of $982.14. Union Public Safety Employees receive preferential rates on certain plan options, while Part Time and Retired/Resigned Participants are offered single and family plans at fixed rates of $982.14 and $2,649.18 respectively. The document also references Critical Illness Coverage premiums organized by attained age bands, though the specific rates for this coverage are not detailed in the provided excerpt. This premium schedule directly supports RFP #2021-04, Dunn County's dental services procurement initiative.

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Att G - 2021 Employee Employer Contribution Rates.pdf PDF
Att D3 - 2019 Dental and Health Premiums.pdf PDF
Att D2 - 2018 Dental and Health Premiums.pdf PDF
Att F3 - 2021 Renewal Anthem.pdf PDF
Att D4 - 2020 Dental and Health Premiums.pdf PDF
Att D1 - 2017 Dental and Health Premiums.pdf PDF
Att C2 - Certificate of Coverage Freestanding DPPO Anthem.pdf PDF
Att C1 - Certificate of Coverage Dentacare DHMO Anthem.pdf PDF
Addendum 1 QA as of 3.31.pdf PDF
Att F1 - 2019 Renewal Anthem.pdf PDF
Att B - Benefit Summary Comparison of Dental Plans.pdf PDF
Att E - Claims and Enrollment Reporting Anthem.pdf PDF
2021-03 Health and Wellness Services RFP.pdf PDF
Att F2 - 2020 Renewal Anthem.pdf PDF
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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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