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Health Insurance <br />Kaiser Permanente <br />City of Louisville currently offers medical insurance through Kaiser Permanente to all benefited part-time and <br />full-time employees. Coverage starts on the first day of the month following your date of hire. Coverage is also <br />extended to your spouse and eligible dependents. <br />Employees who waive health insurance coverage and subsequently experience a qualified change in their <br />status may enroll in a City provided health insurance plan within thirty-one (31) calendar days of the qualifying <br />event. Because plan choices and features may change from year to year, more details are provided in the <br />annual plan summary, insurance plan documents and other enrollment materials. The Summary Plan <br />Description document describes in detail what coverage is provided, and what constitutes an eligible <br />dependent. <br />The City offers three types of medical plans through Kaiser Permanente: an HMO, a High Deductible Health <br />Plan (HDHP) with a Health Savings Account (HSA) and a 3 -Option POS. <br />What is a High Deductible Health Plan (HDHP)? <br />A High Deductible Health Plan is a plan with a minimum annual deductible and a maximum out-of-pocket limit <br />as listed below. These minimums and maximums are determined annually by the Internal Revenue Service <br />(IRS) and are subject to change. <br />What is a health savings account (HSA)? <br />Otherwise known as an HSA, a health savings account can be funded in one of three ways: with your tax- <br />exempt dollars, by your employer, or both. Funds may be used to help pay for eligible medical expenses not <br />covered by an insurance plan, including the deductible, coinsurance, and even in some cases, health <br />insurance premiums as well as dental or vision expenses. If you are enrolled in a HDHP, you may not be <br />enrolled in any other plan (with your spouse or otherwise) or you lose your eligibility to have an HSA as defined <br />by the IRA. For more IRS regulations details, refer to IRS Publication 969. <br />How much can I contribute to an HSA? (INCREASED LIMIT for 2017) <br />As noted by federal law, the 2017 annual contribution limits are: $3,400 for INDIVIDUAL coverage and $6,750 <br />for FAMILY coverage. Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000. <br />Kaiser Permanente <br />BENEFITS LEVEL: TIER 1 <br />Kaiser Employee City <br />Plan Share Share <br />City <br />HSA <br />Contribution <br />Total City Total <br />Cost Premium <br />HMO <br />EE Only <br />$ 87.22 <br />$ 494.24 <br />$ 494.24 <br />$ 581.46 <br />EE+S <br />$ 258.16 <br />$ 1,032.62 <br />$ 1,032.62 <br />$ 1,290.78 <br />EE+C <br />$ 217.47 <br />$ 869.86 <br />$ 869.86 <br />$ 1,087.33 <br />Family <br />$ 436.12 <br />$ 1,308.38 <br />$ 1,308.38 <br />$ 1,744.50 <br />HDHP <br />EE Ordy <br />Family <br />$ 427.39 <br />$ 66.85 <br />$ 494.24 <br />$ 427.39 <br />$ 948.85 <br />$ 83.77 <br />$ 1,032.62 <br />$ 948.85 <br />$ 799.22 <br />$ 70.64 <br />$ 869.86 <br />$ 799.22 <br />$ 1,282.22 <br />$ 26.16 <br />$ 1,308.38 <br />$ 1,282.22 <br />3-0 tion POS <br />EE Only <br />EE+S <br />EE+C <br />Family <br />$ 209.31 <br />$ 545.66 <br />$ 445.78 <br />$ 802.28 <br />$ 494.24 <br />$ 494.24 <br />$ 703.55 <br />$ 1,032.62 <br />$ 1,032.62 <br />$ 1,578.28 <br />$ 869.86 <br />$ 869.86 <br />$ 1,315.64 <br />$ 1,308.38 <br />$ 1,308.38 <br />$ 2,110.66 <br />5 <br />Monthly Rates <br />BENEFITS LEVEL: TIER 2 <br />Kaiser Employee City <br />Plan Share Share <br />City <br />HSA <br />Contribution <br />Total City Total <br />Cost Premium <br />HMO <br />EE Only <br />EE+S <br />EE+C <br />Family <br />$ 149.00 <br />$ 387.24 <br />$ 326.20 <br />$ 599.67 <br />$ 432.46 <br />$ 432.46 <br />$ 903.54 <br />$ 903.54 <br />$ 761.13 <br />$ 761.13 <br />$ 1,144.83 <br />$ 1,144.83 <br />$ 581.46 <br />$ 1,290.78 <br />$ 1,087.33 <br />$ 1,744.50 <br />HDHP <br />EE Only <br />EE+S <br />EE+C <br />Family <br />3 -Option POS <br />$ 53.42 <br />EE Only <br />EE+S <br />EE+C <br />Family <br />$ 373.97 <br />$ 58.49 <br />$ 432.46 <br />$ 118.61 <br />$ 830.24 <br />$ 73.30 <br />$ 903.54 <br />$ 99.90 <br />$ 699.32 <br />$ 61.81 <br />$ 761.13 <br />$ 160.28 <br />$ 1,121.94 <br />$ 22.89 <br />$ 1,144.83 <br />$ 427.39 <br />$ 948.85 <br />$ 799.22 <br />$ 1,282.22 <br />$ 271.09 $ 432.46 $ <br />$ 674.74 $ 903.54 $ <br />$ 554.51 $ 761.13 $ <br />$ 965.83 $ 1,144.83 $ <br />$ 432.46 <br />$ 903.54 <br />$ 761.13 <br />$ 1,144.83 <br />$ 703.55 <br />$ 1,578.28 <br />$ 1,315.64 <br />$ 2,110.66 <br />