2008 Part Time Classified Employee - Insurance Premium, Contribution and Subsidy Information

Part-time employees include Part-time, Seasonal Part-time, Intermittent, and Job Share employees who have at least 80 paid, regular hours in the month. The dollars available to you for purchase of benefits are pro-rated according to the hours you work in a given month, up to the maximum amount for 160 paid hours. Your monthly benefit contribution/subsidy may be applied to any of the PEBB plans listed below.

The table below lists the monthly contribution you will receive to help pay for your benefits. The monthly contribution is based on number of hours worked on average for each pay period.

Use the following instructions to help you estimate the amount of your monthly premium cost (if any) for basic benefits (medical, dental, basic life). Enter the information in the calculation worksheet below. In no case will the amount paid by your agency exceed the cost of premiums for medical, dental and basic life.

1. Using the column at the left in the Pro-Ration Table above, find the hours you work, on average, for each pay period. Next, determine if you will enroll family members in a medical plan, and locate the column that shows your family enrollment tier. Locate the contribution amount on the Pro-Ration Table above to determine the amount the university will contribute towards your insurance. Example: If you work 92 hours, and enroll yourself and family, your total contribution is $675.51. Enter this amount on line 1 of the calculation worksheet below.

If your hours fall between those shown on the table, multiply your expected hours by the Hour Factor (last row of the table) for your medical plan enrollment tier. Example: 114 Hours X 5.3384(Employee Only Tier) = $608.5776, rounded to $608.58. Please note that computer rounding may cause this value to change by a few cents on your pay check.

2. Next enter the amount of the fixed subsidy on line 2 of the calculation worksheet below. The fixed monthly subsidy applies only if you elect a part time medical plan. If you enroll in a full time medical plan, you will not receive the fixed monthly subsidy.

3. Enter premium for your medical and dental plan on lines 5 and 6 of the calculation worksheet below. You can elect either the part-time or the full-time medical and dental plans. Please see the PEBB 2008 Benefit Handbook for plan descriptions.

* If line 3 is more then line 7, your benefits will be fully paid for you. Nothing will be deducted from your paycheck. If line 3 is less then line 7, line 8 will be a negative number. This is your estimated monthly payroll deduction for your medical, dental and basic life coverage.

Note: In some enrollment combinations, the contribution plus subsidy exceeds the cost of coverage. The subsidies shown are maximum subsidies and provide only the amount necessary to fully pay for the coverage selected.

Medical Opt Out Information

If you are covered by another employer group medical plan, you may opt out of medical insurance and receive some cash back in your paycheck as taxable income. If you opt out of medical insurance you must enroll in a PEBB dental plan (you must have at least employee only coverage) and basic life insurance.

Use the following instruction and Opt Out Calculation Worksheet below to determine your cashback.

1. Using the column at the left in the Pro-Ration Table above, find the hours you work, on average, for each pay period. Locate the opt out column, enter this amount on line 1 of the worksheet below.

2. Enter premium for your choice of dental plan on line 3 of the worksheet below. You are required to be enrolled in at least the employee-only for dental coverage. You may also choose to cover eligible dependents.