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)R-1--)4(ouctt a vw <br />To : Regular Full Time Employees <br />From: Finance Department <br />Re: 2010 Health Rates <br />Monthly Employee Annual <br />Monthly City Monthly City H.S.A. <br />Rate Contribution Cost Contribution <br />Health Partners Choice 25 -80% - Single 549.96 549.96 0.00 <br />Health Partners Choice 25 -80% - Family 1,542.79 1,018.23 524.56 <br />Health Partners HSA $3,000/100% - Single 338.16 338.16 0.00 750.00 <br />Health Partners HSA $3,000/100 % - Family 949.61 880.33 69.28 1,500.00 <br />I would like to waive coverage and receive a cash option of $507.88/Mo. <br />(Certain rules pertain to this option. Please see Paula to get a waiver form.) <br />Choice 25 -80% Plan - Rates good January 1, 2010 - December 31, 2010 <br />HSA Plan - Rates good January 1, 2010 - December 31, 2010 <br />City HSA contribution, half on January 4, 2010, remainder on July 1, 2010 <br />