Health and Welfare Summary Plan Description

APPENDIX B
Monthly Coverage Payment Schedules as of February 1, 2014

Early Retirees Ages 55 through 62
Health Plan Monthly Payment
Kaiser $ 1,766.00
Blue Shield HMO $ 1,822.00
Self-Funded PPO $ 2,187.00
Early Retirees Ages 62 through 64 Who Have Already Satisfied Service Requirements to Qualify as a Regular Retiree at age 62 (Section 4.3(d))
Health Plan Monthly Payment
Kaiser $575.00
Blue Shield HMO $ 575.00
Self-Funded PPO $ 575.00
Early Retirees Ages 62 through 64 Who Must Continue Participation as an Early Retire to Qualify as a Regular Retiree at age 62 (Section 4.3(c)
Health Plan Monthly Payment
Kaiser – Single $ 706.00
Kaiser – Family $ 1,060.00
Blue Shield HMO – Single $ 729.00
Blue Shield HMO - Family $ 1,093.00
Self-Funded PPO – Single $ 875.00
Self-Funded PPO – Family $ 1,312.00
Regular Retirees Age 65 and older, Early Retirees Having Reached Age 65 and Older, Disabled Retirees, Surviving Spouses -- All Plans
Age Monthly Payment
Under Age 65 $ 500.00
Ages 65 through 74
and retirees who attain age 75 on or after 1/1/2008;
Single: $ 220.00
Family: $ 440.00
Retirees who attained age 75 before 1/1/2007 $ 0.00