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    Cost Summary

    Explanation of Benefits

    Health Care Summary EOB
    Beyond Health Care Summary EOB

    Coverage Plan

    Employee Contribution

    City Contribution

    Total Monthly Cost
    Employee Only $26 $489 $515
    Employee + Child $264 $561 $825
    Employee + Children $379 $806 $1,185
    Employee + Spouse $330 $701 $1,031
    Family $540 $1,156 $1,700
    Family (both employees)** $153 $1,547 $1,700

    **This coverage tier is only available to eligible employees enrolled prior to January 1, 2016.
     

    Vision Plan

    City Contribution per month

    Employee Contribution per month

    Employee Only $4.08
    $3.91 effective 1/1/2022
    $0
    Employee + Dependent
    (spouse or one child)
    $4.16 $4
    $3.67 effective 1/1/2022
    Family $4.24 $8
    $7.50 effective 1/1/2022

     

    Prescription Coverage

    City Cost

    Employee Cost

    Administered by
    Anthem Blue Cross
    60% for 30-day supply 40% for 30-day supply

     

    Dental Plan

    City Contribution per month

    Employee Contribution per month

    Employee Only $28 $0
    Employee + Dependent
    (spouse or one child)
    $28 $22
    Family $28 $39

     

    Retirement

    City Contribution

    Employee Contribution

    Virginia Retirement System
    (VRS)
    The City pays employer portion (19.66%) of base pay towards the retirement and disability benefit Employees pay the 5% member portion of this benefit
    457 Deferred Compensation Retirement Plan (MissionSquare, formerly ICMA) No match  Min. $5 per pay period
    2020: Max. up to $19,500 annually or $26,000 if age 50+

     

    Group Life Insurance

    City Contribution

    Group Life Insurance
    2x annual pay - natural death
    4x annual pay - accidental death
    1.34% of pay

    Optional Life Insurance Coverage

    How to calculate monthly cost of optional life insurance:

    1. Decide how much additional life insurance you want for yourself. Choose Option 1, 2, 3, or 4 and whether you want coverage on spouse and children.
    2. Find cost per $1,000 of coverage next to your age in Employee + Spouse Rates table below.
    3. Multiply cost times per $1,000 of life insurance coverage. For example, if one times your annual base pay is $20,000, and your age is 35, you would multiply 20 times .06 to find a monthly cost of $1.20.
    4. Based on option chosen and corresponding spouse coverage, if any, repeat formula using cost based on spouse's age for spouse premium.
    5. Children's premium is a flat rate based on the option you choose. See rates below.

    Optional Life Coverage

    Employee

    Spouse

    Children

    Option Insurance Amount Insurance Amount Insurance Amount
    1 1x Annual Base Pay .5 Employee Base Pay $10,000
    2 2x Annual Base Pay 1x Employee Base Pay $10,000
    3 3x Annual Base Pay 1.5x Employee Base Pay $20,000
    4 4x Annual Base Pay 2x Employee Base Pay $30,000

     

    Optional Life Rates

    Employee + Spouse

    Age Monthly Rates Per $1000
    Under 30 $0.05
    30 - 34 $0.05
    35 - 39 $0.06
    40 - 44 $0.08
    45 - 49 $0.14
    50 - 54 $0.20
    55 - 59 $0.33
    60 - 64 $0.59
    65 - 69 $1.06
    70 and over $2.06

     

    Optional Life Rates

    Children

     

    Option Insurance Amount Flat Monthly Rate
    1 $10,000 $0.80
    2 $10,000 $0.80
    3 $20,000 $1.60
    4 $30,000 $2.40
     

    Cost of Maintaining Coverage When Employment Ends

    Medical Coverage

    Monthly COBRA Rate

    Individual Only $525
    Individual + Spouse $1,052
    Individual + Child $842
    Individual + Children $1,209
    Family $1,734
    Family - Two Married City Employees $1,734

     

    Dental Coverage

    Monthly COBRA Rate

    Individual Only $29
    Individual + One $51
    Family $68

     

    Vision Coverage

    Monthly COBRA Rate

    Individual Only $4.16
    $3.91 effective 1/1/2022
    Individual + One $8.32
    $7.83 effective 1/1/2022
    Family $12.48
    $11.74 effective 1/1/2022

    You will receive information in the mail from HR about COBRA.