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City of Laramie Health Insurance Cost Summary FY13 Eff. 8‐1‐2012 Employees will have the option of accepting the standard coverage or “buying up” to the coverage with the lower deductible. The City of Laramie has a self‐insured health insurance plan that is processed through a third party administrator, Blue Cross Blue Shield of Wyoming. Approved by the Health Insurance Committee: effective August 1, 2012. Types of Coverage Employee Cost Employee Cost w/ Buyup Single $ 10.10 $ 58.15 Employee & Dependent $ 136.30 $ 215.83 Employee & Spouse $ 178.10 $ 261.21 Family $ 258.20 $ 358.58 Types of Benefit Costs Standard Buyup Deductible: Single $ 1,000 $ 500 Family $ 2,000 $ 1,000 Coinsurance: 50/50 50/50 Out of Pocket: (Annual Maximum) Single $ 2,000 $ 1,500 Family $ 4,000 $ 3,000 Office Visit Co‐Pay: $ 30.00 per visit N/A Accident Rider: (not subject to deductible) $ 1,500 per year $ 600 per accident Wellness: (not subject to deductible) Unlimited Unlimited Prescriptions: Generic $ 0 + 20% $ 0 + 20% Listed Brand $ 15 + 20% $ 15 + 20% Non‐Listed Brand $ 30 + 50% $ 30 + 50% Out‐of‐Pocket $ 1,500 per person $ 1,500 per person Dental Deductible: Single $ 50 $ 50 Family $ 100 $ 100 This comparison of coverage is intended only as a general description for the principle features of the benefit plans. Please refer to the benefit document for full details.