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	$544	$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	$0
Employee + Dependent (spouse or one child)	$4.08	$3.67 effective 1/1/2022
Family	$4.08	$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 (20.96%) of base pay towards the retirement and disability benefit	Employees pay the 5% member portion of this benefit
457 Deferred Compensation (MissionSquare, formerly ICMA)	N/A	2022: Max. up to $20,500 annually or $27,000 if age 50+ 2023: Max. up to $22,500 annually or $30,000 if age 50+
Roth IRA (MissionSquare, formerly ICMA)	N/A	2022: Max. up to $6,000 annually or $7,000 if age 50+ 2023: Max. up to $6,500 annually or $7,500 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
Individual + One	$7.91
Family	$11.81

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