Medical Coverage Premiums Monthly Rates

Collectively Bargained

School District of Philadelphia (SDP) Contributions

PLAN NAME SINGLE PARENT/ CHILD PARENT/ CHILDREN COUPLE FAMILY
Personal Choice
20/30/70 w/Modifications
SDP
Contribution
$679.92 $951.90 $1,223.87 $1,359.86 $2,039.77
Keystone SDP
Contribution
$575.90 $806.26 $1,036.31 $1,151.80 $1,727.70

*Additional 2% charge added to COBRA rates

Benefit Personal Choice Plan 20/30/70 w/Variations Keystone HMO 15
Deductible Individual/Family In-Network $0/$0 Out of Network* $500 Individual/$1,000 Family N/A
After deductible, Plan pays: 100% 70% N/A

*Those hired before 9/1/10 and are switching to Personal Choice will pay 3% of premium. Those hired on or after 9/1/10 will pay 5%.