Health Care Benefits and Premiums

This information is only valid through June 30, 2009

The following tables indicate the monthly premiums for dependent health care benefits available through the Plan. Currently, healthcare coverage for retirees is provided for by the Plan.

There are three healthcare plans offered to retirees and their dependents -

Blue Cross/Blue Shield PPO, HMO Illinois and UNICARE HMO.

Blue Cross / Blue Shield PPO

Type of Coverage	Monthly Premium until 6/30/2009
Retiree Only Non Medicare	$0.00
Retiree Plus Non Medicare Dependent(s) (PPO #1)	$513.45
Retiree Plus Non Medicare Dependent(s) (PPO #2)	$413.45
Retiree Plus Non Medicare Dependent(s) (PPO #3)	$313.45
Retiree Only Medicare	$0.00
Retiree Plus Medicare Dependent(s)	$217.50

HMO Illinois

Type of Coverage	Monthly Premium until 6/30/2009
Retiree Only Non Medicare	$0.00
Retiree Plus Non Medicare Dependent(s)	$476.28
Retiree Only Medicare	$0.00
Retiree Plus Medicare Dependent(s)	$226.86

UNICARE HMO

Type of Coverage	Monthly Premium until 6/30/2009
Retiree Only Non Medicare	$0.00
Retiree Plus Non Medicare Dependent(s)	$464.09
Retiree Only Medicare	$0.00
Retiree Plus Medicare Dependent(s)	$232.78

Supporting Forms and Application

All forms may not be required.

Completed signed forms must be received in the Pension Office no later than the fourteenth (14th) day of the month preceding your month of retirement.  For example, if you wish to retire on June 1st, your completed application must be in the Retirement Plan Office no later than May 14th.

NEW Health Care Enrollment Form - coverage from 7-01-2009 to 12-31-2010 - Health Care Enrollment Form for retirees, disabled pensioners, surviving spauses and dependents 2009 - 2010 OPEN ENROLLMENT