Health Care:

Self-Funded
Third Party Administrator:
Cigna Healthcare
207 Regency Executive Park Drive
Charlotte, North Carolina 28217

Premiums:	County Pays:	Employee Pays:
Employee Only	$464.00	$  30.00
Employee and 1 Child	$464.00	$150.00
Employee and Spouse	$464.00	$260.00
Employee and Children	$464.00	$305.00
Employee and Family	$464.00	$400.00

Plan Coverage:

Major Medical benefits are provided for regular employees scheduled to work 30 or more hours per week. Following is a brief plan summary:

In-Network physician $20.00 co-pay for primary care physician office visit, $40.00 for specialist office visit.
A $500.00 deductible applies to some services and payable at 80% or $1000.00 deductible and payable at 60% Out-of-Network.
Coverage is available, at current group rates, for your eligible dependents.
Coverage is effective on the first day of the month following a 30 day waiting period. Benefit period is from 7-1-04 thru 6-30-05

Workers' Compensation Coverage:

NC Assoc. of County Commissioners
Risk Management Pools 100 North Tryon Street
Suite 3200
Charlotte, NC 28202

Dental:

Assurant / Fotis
PO Box 2940
Clinton, IA 52733

Premiums:	County Pays:	Employee Pays:
Employee Only	$16.50	$  5.00
Employee and 1 Child	$16.50	$22.08
Employee and Children	$16.50	$35.45
Employee and Spouse	$16.50	$35.45
Employee and Family	$16.50	$59.98

Maximum benefit per plan year $2000.00 with a $50.00 deductible. Orthodontic lifetime maximum $1000.00 Preventive procedures paid at 100%, basic procedures paid at 80% and major procedures paid at 50% of reasonable and customary charges.

Life Insurance:

Department Heads:	$50,000
Supervisors:	$25,000
Other Employees	$10,000

Basic and Accidental Death and Dismemberment coverage is provided by the County. Supplemental coverage is available at employee cost, to increase the above amounts by 1x, 2x or 3x.

All of the above information is provided as information only and is not intended as the official interpretation or explanation of benefits. Please consult your employee booklets for specific details.