MoDOT/MSHP 2018 MEDICAL INSURANCE …

1 MoDOT/MSHP 2018 MEDICAL INSURANCE MONTHLY PREMIUMS. EFFECTIVE JANUARY 1, 2018. MoDOT/MSHP Aetna PPO Plan Rate Category Premium Employer Share Subscriber's Cost ACTIVE EMPLOYEE MEMBERS. Subscriber Only $ $ $ Subscriber/Family $1, $1, $ Subscriber/Spouse $1, $ $ Subscriber/Child $ $ $ Subscriber/2 Children $ $ $ NON-MEDICARE RETIREE MEMBERS. Subscribers retiring effective 1/1/2015 and later will receive a state contribution of 2 percent per year of service, not to exceed 50 percent. Retiree - Subscriber Only $ $ $ Retiree - Subscriber/Family $2, $ $1, Retiree - Subscriber/Spouse $1, $ $ Retiree - Subscriber/Child $1, $ $ Retiree - Subscriber/2 Children $1, $ $ Retiree - Non-Medicare Subscriber/Medicare Child $ $ $ Retiree - Non-Medicare Subscriber/Medicare Spouse $ $ $ MEDICARE MEMBERS.

2 Subscribers retiring effective 1/1/2015 and later will receive a state contribution of 2 percent per year of service, not to exceed 50 percent. Retiree - Medicare Subscriber Only $ $ $ Retiree - Medicare Subscriber/Non-Medicare Spouse $ $ $ Retiree - Medicare Subscriber/Medicare Spouse $ $ $ Retiree - Medicare Subscriber/Non-Medicare Family $1, $ $ Retiree - Medicare Subscriber/Medicare Family $1, $ $ Retiree - Medicare Subscriber/Child $ $ $ Retiree - Medicare Subscriber/Medicare Child $ $ $ Retiree - Medicare Subscriber/2 Children $1, $ $ Survivor - Medicare Subscriber Only $ $ $ Survivor - Medicare Subscriber/Non-Medicare Family $1.

3 $ $ Survivor - Medicare Subscriber/Medicare Family $1, $ $ Survivor - Medicare Subscriber/Child $ $ $ Survivor - Medicare Subscriber/Medicare Child $ $ $ Survivor - Medicare Subscriber/2 Children $1, $ $ 9. MoDOT/MSHP Aetna PPO Plan Rate Category Premium Employer Share Subscriber's Cost MEDICARE MEMBERS (continued). LTD - Medicare Subscriber Only $ $ $ LTD - Medicare Subscriber/Non-Medicare Spouse $ $ $ LTD - Medicare Subscriber/Medicare Spouse $ $ $ LTD - Medicare Subscriber/Non-Medicare Family $1, $ $ LTD - Medicare Subscriber/Medicare Family $1, $ $ LTD - Medicare Subscriber/Child $ $ $ LTD - Medicare Subscriber/2 Children $1, $ $ WRD - Medicare Subscriber Only $ $ $ WRD - Medicare Subscriber/Non-Medicare Spouse $ $ $ WRD - Medicare Subscriber/Medicare Spouse $ $ $ WRD - Medicare Subscriber/Non-Medicare Family $1, $1.

4 $ WRD - Medicare Subscriber/Medicare Family $1, $ $ WRD - Medicare Subscriber/Child $ $ $ WRD - Medicare Subscriber/2 Children $ $ $ Vested - Medicare Subscriber Only $ $ $ Vested - Medicare Subscriber/Non-Medicare Family $1, $ $1, Vested - Medicare Subscriber/Medicare Family $1, $ $1, Vested - Medicare Subscriber/Medicare Spouse $ $ $ Vested - Medicare Subscriber/Non-Medicare Spouse $ $ $ Vested - Medicare Subscriber/Child $ $ $ Vested - Medicare Subscriber/2 Children $ $ $ LTD = Long Term Disability WRD = Work Related Disability 10. MoDOT/MSHP Aetna PPO Plan Rate Category Premium Employer Share Subscriber's Cost OTHER PLAN CATEGORIES.

5 Subscribers retiring effective 1/1/2015 and later will receive a state contribution of 2 percent per year of service, not to exceed 50 percent. - Subscriber Only $ $ $ - Subscriber/Family $1, $ $1, - Subscriber/Spouse $1, $ $1, - Subscriber/Child $ $ $ - Subscriber/2 Children $ $ $ WRD - Subscriber Only $ $ $ WRD - Subscriber/Family $1, $1, $ WRD - Subscriber/Spouse $1, $ $ WRD - Subscriber/Child $ $ $ WRD - Subscriber/2 Children $ $ $ LTD - Subscriber Only $ $ $ LTD - Subscriber/Family $2, $ $1, LTD - Subscriber/Spouse $1, $ $ LTD - Subscriber/Child $1, $ $ LTD - Subscriber/2 Children $1.

6 $ $ LTD - Non-Medicare Subscriber/Medicare Child $ $ $ LTD- Non-Medicare Subscriber/Medicare Spouse $ $ $ Survivor - Subscriber Only $ $ $ Survivor - Subscriber/Family $2, $ $1, Survivor - Subscriber/Child $1, $ $ Survivor - Non-Medicare Subscriber/Medicare Child $ $ $ Survivor - Subscriber/2 Children $1, $ $ Vested - Subscriber Only $ $ $ Vested - Subscriber/Family $1, $ $1, Vested - Subscriber/Spouse $1, $ $1, Vested - Non-Medicare Subscriber/Medicare Spouse $ $ $ Vested - Subscriber/Child $ $ $ Vested - Subscriber/2 Children $ $ $ LTD = Long Term Disability WRD = Work Related Disability 11.

7 MoDOT/MSHP Aetna High Deductible Plan MoDOT/MSHP Aetna HDHP. Available Statewide Rate Category Premium Employer Share Subscriber's Cost ACTIVE EMPLOYEE MEMBERS. Subscriber Only $ $ $ Subscriber/Family $1, $1, $ Subscriber/Spouse $1, $ $ Subscriber/Child $ $ $ Subscriber/2 Children $ $ $ NON-MEDICARE RETIREE MEMBERS. Subscribers retiring effective 1/1/2015 and later will receive a state contribution of 2 percent per year of service, not to exceed 50 percent. Retiree - Subscriber Only $ $ $ Retiree - Subscriber/Family $1, $ $ Retiree - Subscriber/Spouse $1, $ $ Retiree - Subscriber/Child $1, $ $ Retiree - Subscriber/2 Children $1, $ $ OTHER PLAN CATEGORIES.

8 Subscribers retiring effective 1/1/2015 and later will receive a state contribution of 2 percent per year of service, not to exceed 50 percent. - Subscriber Only $ $ $ - Subscriber/Family $1, $ $1, - Subscriber/Spouse $1, $ $1, - Subscriber/Child $ $ $ - Subscriber/2 Children $ $ $ WRD - Subscriber Only $ $ $ WRD - Subscriber/Family $1, $1, $ WRD - Subscriber/Spouse $1, $ $ WRD - Subscriber/Child $ $ $ WRD - Subscriber/2 Children $ $ $ LTD - Subscriber Only $ $ $ LTD - Subscriber/Family $1, $ $ LTD - Subscriber/Spouse $1, $ $ LTD - Subscriber/Child $1, $ $ LTD - Subscriber/2 Children $1, $ $ Survivor - Subscriber Only $ $ $ Survivor - Subscriber/Family $1.

9 $ $ Survivor - Subscriber/Child $1, $ $ Survivor - Subscriber/2 Children $1, $ $ Vested - Subscriber Only $ $ $ Vested - Subscriber/Family $1, $ $1, Vested - Subscriber/Spouse $1, $ $1, Vested - Subscriber/Child $ $ $ Vested - Subscriber/2 Children $ $ $ 12.