Page 13 - Inglewood USD Benefits Guide 2019 - ACTIVES_FINAL

EARLY RETIREE CONTRIBUTIONS

CLASSIFIED & CONFIDENTIAL

Anthem Blue Cross Employees working 7-8 Employees working less Employees working less Employees working less
Classic PPO hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
500/30/20 hours per day hours per day hours per day
Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays

Retiree Only $1,278.45 $537.01 $1,278.45 $537.01 $1,479.83 $335.63 $1,546.96 $268.51
Retiree + 1 $2,684.72 $1,124.44 $2,965.83 $843.33 $3,106.39 $702.78 $3,246.94 $562.22
Retiree + Family $3,835.32 $1,605.05 $4,236.58 $1,203.79 $4,437.21 $1,003.16 $4,637.85 $802.53

Anthem Blue Cross Employees working 7-8 Employees working less Employees working less Employees working less
Solutions PPO hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
2000/20/20 hours per day hours per day hours per day
Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays
Retiree Only $921.82 $537.01 $921.82 $537.01 $1,123.20 $335.63 $1,190.33 $268.51
Retiree + 1 $1,935.80 $1,124.44 $2,216.91 $843.33 $2,357.47 $702.78 $2,498.02 $562.22
Retiree + Family $2,765.44 $1,605.05 $3,166.70 $1,203.79 $3,367.33 $1,003.16 $3,567.97 $802.53
¹
Dental Plan – 2019 Monthly Premiums

Delta Dental PPO Employees working 7-8 Employees working less Employees working less Employees working less
hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
hours per day hours per day hours per day
Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays

Retiree Only $58.40 $0.00 $58.40 $0.00 $58.40 $0.00 $58.40 $0.00
Retiree + 1 $105.78 $0.00 $105.78 $0.00 $105.78 $0.00 $105.78 $0.00
Retiree + Family $152.06 $0.00 $152.06 $0.00 $152.06 $0.00 $152.06 $0.00
Vision Plan – 2019 Monthly Premiums
¹
VSP Vision PPO Employees working 7-8 Employees working less Employees working less Employees working less
hours per day than 7 hours/More than 6 than 6 Hours/More than 5 than 5 hours/More than 4
hours per day hours per day hours per day
Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays Retiree Pays IUSD Pays
Retiree Only $16.40 $0.00 $16.40 $0.00 $16.40 $0.00 $16.40 $0.00
Retiree + 1 $30.47 $0.00 $30.47 $0.00 $30.47 $0.00 $30.47 $0.00
Retiree + Family $46.92 $0.00 $46.92 $0.00 $46.92 $0.00 $46.92 $0.00
¹Early retirees shall make payments to Inglewood USD for any premium amounts exceeding the District Contribution by the first of each month

*Unit members who retired prior to January 1, 2016, shall be eligible for a District annual contribution toward District medical insurance equal to active employees
in accordance with Section 13.1.1 and subject to the conditions listed in Section 13.2.
**Eligible full time unit members who retire after January 1, 2016, shall be eligible for a District contribution for employee only medical coverage equal to active
employees in accordance with section 13.2 and subject to the conditions listed in Section 13.2.
***No Dependent Coverage for Retirements on or after 1/1/16

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