TABLE OF CONTENTS
APPENDIX C
EGI Participant Costs 1996-2000

 

Low-Deductible Option (Individual)

2000

1999

1998

1997

1996

Individual Premium

$195.00

$168.10

$156.50

$156.50

$143.58

Employee Share of Individual Premium

$0

$0

$0

$0

$0

Employer Share of Individual Premium

$225

$200

$175

$175

$175

Percent Paid by Employer(1)

115%

119%

112%

112%

122%

Deductible

$350

$350

$250

$250

$250

Prescription Drug Deductible(2)

N/A

$250

N/A

N/A

N/A

Co-Insurance Maximums (3)

$10,000

$10,000

$10,000

$10,000

$5,000

Co-Insurance Max (Out-of-state non-network)(3)

$15,000

$15,000

$15,000

$15,000

$15,000

Co-Insurance (In-state network)

85%

85%

80%

80%

80%

Co-Insurance (In-state non-network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state non-network)

60%

60%

60%

60%

70%

Co-Pays(4)

$10, $20, $40

N/A

N/A

N/A

N/A

Lifetime Maximums

$2,000,000

$2,000,000

$2,000,000

$2,000,000

$2,000,000

High-Deductible Option (Individual)

2000

1999

1998

1997

1996

Individual Premium

$169.94

$146.50

$136.40

$136.40

$125.14

Employee Share of Individual Premium

$0

$0

$0

$0

$0

Employer Share of Individual Premium

$225

$200

$175

$175

$175

Percent Paid by Employer(1)

132%

137%

128%

128%

140%

Deductible

$750

$750

$750

$750

$750

Prescription Drug Deductible(2)

N/A

$250

N/A

N/A

N/A

Co-Insurance Maximums (3)

$10,000

$10,000

$10,000

$10,000

$5,000

Co-Insurance Max (Out-of-state non-network)(3)

$15,000

$15,000

$15,000

$15,000

$15,000

Co-Insurance (In-state network)

85%

85%

80%

80%

80%

Co-Insurance (In-state non-network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state non-network)

60%

60%

60%

60%

70%

Co-Pays(4)

$10, $20, $40

N/A

N/A

N/A

N/A

Lifetime Maximums

$2,000,000

$2,000,000

$2,000,000

$2,000,000

$2,000,000

 

Low-Deductible Option (Family)

2000

1999

1998

1997

1996

Family Premium

$451.28

$389.04

$362.20

$362.20

$332.30

Employee Share of Family Premium

$226.28

$189.04

$187.20

$187.20

$157.30

Employer Share of Family Premium

$225

$200

$175

$175

$175

Percent Paid by Employer(1)

50%

51%

48%

48%

53%

Deductible

$700

$700

$500

$500

$500

Prescription Drug Deductible(2)

N/A

$500

N/A

N/A

N/A

Co-Insurance Maximums (3)

$20,000

$20,000

$20,000

$20,000

$10,000

Co-Insurance Max (Out-of-state non-network)(3)

$30,000

$30,000

$30,000

$30,000

$30,000

Co-Insurance (In-state network)

85%

85%

80%

80%

80%

Co-Insurance (In-state non-network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state non-network)

60%

60%

60%

60%

70%

Co-Pays(4)

$10, $20, $40

N/A

N/A

N/A

N/A

Lifetime Maximums

$2,000,000

$2,000,000

$2,000,000

$2,000,000

$2,000,000

High-Deductible Option (Family)

2000

1999

1998

1997

1996

Family Premium

$390.68

$336.80

$313.56

$313.56

$287.66

Employee Share of Family Premium

$165.68

$136.80

$138.56

$138.56

$112.66

Employer Share of Family Premium

$225

$200

$175

$175

$175

Percent Paid by Employer(1)

58%

59%

56%

56%

61%

Deductible

$1,500

$1,500

$1,500

$1,500

$1,500

Prescription Drug Deductible(2)

N/A

$500

N/A

N/A

N/A

Co-Insurance Maximums (3)

$20,000

$20,000

$20,000

$20,000

$10,000

Co-Insurance Max (Out-of-state non-network)(3)

$30,000

$30,000

$30,000

$30,000

$30,000

Co-Insurance (In-state network)

85%

85%

80%

80%

80%

Co-Insurance (In-state non-network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state network)

80%

80%

80%

80%

80%

Co-Insurance (Out-of-state non-network)

60%

60%

60%

60%

70%

Co-Pays(4)

$10, $20, $40

N/A

N/A

N/A

N/A

Lifetime Maximums

$2,000,000

$2,000,000

$2,000,000

$2,000,000

$2,000,000

Low-Deductible Option (Pre-Medicare Individual)

2000

1999

1998

1997

1996

Individual Premium

$223.62

$192.78

$179.48

$179.48

$143.58

Retiree Share of Individual Premium

$223.62

$192.78

$179.48

$179.48

$143.58

Employer Share of Individual Premium

$0

$0

$0

$0

$0

Percent Paid by Employer(1)

0%

0%

0%

0%

0%

High-Deductible Option (Pre-Medicare Individual)

2000

1999

1998

1997

1996

Individual Premium

$194.92

$168.04

$156.44

$156.44

$125.14

Retiree Share of Individual Premium

$194.92

$168.04

$156.44

$156.44

$125.14

Employer Share of Individual Premium

$0

$0

$0

$0

$0

Percent Paid by Employer(1)

0%

0%

0%

0%

0%

Low-Deductible Option (Pre-Medicare Family)

2000

1999

1998

1997

1996

Family Premium

$533.04

$459.52

$427.82

$427.82

$342.24

Retiree Share of Family Premium

$533.04

$459.52

$427.82

$427.82

$342.24

Employer Share of Family Premium

$0

$0

$0

$0

$0

Percent Paid by Employer(1)

0%

0%

0%

0%

0%

High-Deductible Option (Pre-Medicare Family)

2000

1999

1998

1997

1996

Family Premium

$461.36

$397.72

$370.28

$370.28

$296.20

Retiree Share of Family Premium

$461.36

$397.72

$370.28

$370.28

$296.20

Employer Share of Family Premium

$0

$0

$0

$0

$0

Percent Paid by Employer(1)

0%

0%

0%

0%

0%

Deductible

$1,500

$1,500

$1,500

$1,500

$1,500

Low-Deductible Option (Medicare Individual)

2000

1999

1998

1997

1996

Individual Premium

N/A

$134.30

$125.04

$125.04

$108.72

Retiree Share of Individual Premium

N/A

$134.30

$125.04

$125.04

$108.72

Employer Share of Individual Premium

N/A

$0

$0

$0

$0

Percent Paid by Employer(1)

N/A

0%

0%

0%

0%

High-Deductible Option (Medicare Individual)

2000

1999

1998

1997

1996

Individual Premium

$174.06

$115.90

$107.90

$107.90

$93.82

Retiree Share of Individual Premium

$174.06

$115.90

$107.90

$107.90

$93.82

Employer Share of Individual Premium

$0

$0

$0

$0

$0

Percent Paid by Employer(1)

0%

0%

0%

0%

0%

Low-Deductible Option (Medicare Family)

2000

1999

1998

1997

1996

Family Premium

N/A

$265.86

$247.52

$247.52

$215.22

Retiree Share of Family Premium

N/A

$265.86

$247.52

$247.52

$215.22

Employer Share of Family Premium

N/A

$0

$0

$0

$0

Percent Paid by Employer(1)

N/A

0%

0%

0%

0%

High-Deductible Option (Medicare Family)

2000

1999

1998

1997

1996

Family Premium

$344.06

$229.10

$213.30

$213.30

$185.46

Retiree Share of Family Premium

$344.06

$229.10

$213.30

$213.30

$185.46

Employer Share of Family Premium

$0

$0

$0

$0

$0

Percent Paid by Employer(1)

0%

0%

0%

0%

0%

(1) Preventative dental is mandatory, which costs an additional $7.50 (single) and $8.28 (family).  Life insurance premiums (vary) for employees also come out of the employer contribution.

(2)  From 1996 to 1998, there was an 80 percent co-insurance rate for prescription drugs, a $250 deductible applied in 1999, and the board "carved out" the prescription benefit in 2000, using a co-pay rather than a deductible or co-insurance.

(3)  Certain expenses do not work toward the breakpoint, including deductibles, drug co-pays, outpatient treatment of mental/nervous conditions, and substance abuse.

(4) Co-pays are for prescription drugs, 100 percent paid after co-pay

 

Source:  LSO analysis of 1996, 1997, 1998, 1999, 2000 Employee Benefit Booklets, summary of state contributions and premiums provided by Employees’ Group Insurance.

 

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