CITY OF CHICAGO
MONTHLY RATES FOR ANNUITANT HEALTHCARE PLANS
EFFECTIVE DATE - JULY 1, 2010

CATEGORY
PLAN
2010 ANNUITANT
CONTRIBUTION RATES
RETIRED ON / AFTER 07/01/2005  WITH 20 YEARS OF SERVICE  
                                                                                   (City Share at 50%)
ANNUITANT  
MEDICARE            
$95
NON-MEDICARE            
$314
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$248
MEDICARE / NON-MEDICARE           
$497
NON-MEDICARE / MEDICARE            
$467
NON-MEDICARE NON-MEDICARE             
$706
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$208
NON-MEDICARE / CHILD(REN)            
$417
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$362
MED / NON / CHILD(REN)            
$600
NON / MED / CHILD(REN)            
$570
NON / NON / CHILD(REN)            
$809
CHILD(REN)  
CHILD(REN)            
$  25
     

RETIRED ON / AFTER 07/01/2005  WITH 15-19 YEARS OF SERVICE  
                                                                                   (City Share at 45%)

ANNUITANT  
MEDICARE            
$111
NON-MEDICARE            
$355
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$280
MEDICARE / NON-MEDICARE           
$554
NON-MEDICARE / MEDICARE            
$524
NON-MEDICARE NON-MEDICARE             
$786
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$236
NON-MEDICARE / CHILD(REN)            
$468
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$404
MED / NON / CHILD(REN)            
$667
NON / MED / CHILD(REN)            
$637
NON / NON / CHILD(REN)            
$900
CHILD(REN)  
CHILD(REN)            
$  37
     

RETIRED ON / AFTER 07/01/2005  WITH 10-14 YEARS OF SERVICE  
                                                                                   (City Share at 40%)

ANNUITANT  
MEDICARE            
$127
NON-MEDICARE            
$396
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$311
MEDICARE / NON-MEDICARE           
$610
NON-MEDICARE / MEDICARE            
$580
NON-MEDICARE NON-MEDICARE             
$866
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$263
NON-MEDICARE / CHILD(REN)            
$520
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$447
MED / NON / CHILD(REN)            
$733
NON / MED / CHILD(REN)            
$703
NON / NON / CHILD(REN)            
$990
CHILD(REN)  
CHILD(REN)            
$49
   

RETIRED ON / AFTER 07/01/2005  WITH LESS THAN 10 YEARS OF SERVICE  
                                                                                   (City Share at 0%)

ANNUITANT  
MEDICARE            
$255
NON-MEDICARE            
$723
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$562
MEDICARE / NON-MEDICARE           
$1,060
NON-MEDICARE / MEDICARE            
$1,030
NON-MEDICARE NON-MEDICARE             
$1,507
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$482
NON-MEDICARE / CHILD(REN)            
$929
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$788
MED / NON / CHILD(REN)            
$1,266
NON / MED / CHILD(REN)            
$1,236
NON / NON / CHILD(REN)            
$1,713
CHILD(REN)  
CHILD(REN)            
$145
   
   
RETIRED ON / AFTER 08/23/1989 and BEFORE 07/01/2005    (City Share at 55%)
ANNUITANT  
MEDICARE            
$79
NON-MEDICARE            
$273
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$217
MEDICARE / NON-MEDICARE           
$441
NON-MEDICARE / MEDICARE            
$411
NON-MEDICARE NON-MEDICARE             
$626
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$181
NON-MEDICARE / CHILD(REN)            
$366
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$319
MED / NON / CHILD(REN)            
$534
NON / MED / CHILD(REN)            
$504
NON / NON / CHILD(REN)            
$719
CHILD(REN)  
CHILD(REN)            
$  13
     
RETIRED BEFORE 08/23/1989:    
ANNUITANT    

MEDICARE            

$79
NON-MEDICARE            
$79
ANNUITANT AND SPOUSE  
MEDICARE / MEDICARE            
$217
MEDICARE / NON-MEDICARE            
$217
NON-MEDICARE / MEDICARE             
$217
NON-MEDICARE NON-MEDICARE           
$217
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$181
NON-MEDICARE / CHILD(REN)            
$181
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$319
MED / NON / CHILD(REN)           
$319
NON / MED / CHILD(REN)           
$319
NON / NON / CHILD(REN)           
$319
CHILD(REN)  
CHILDREN            
$ 13
   
BORN BEFORE 12/31/1913 & AFTER 12/31/1908 RETIREE CAPPED RATES PER AGREEMENT
ANNUITANT  
MEDICARE            
$51
NON-MEDICARE            
$80
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$147
MEDICARE / NON-MEDICARE            
$178
NON-MEDICARE / MEDICARE            
$134
NON-MEDICARE NON-MEDICARE            
$190
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$64
NON-MEDICARE / CHILD(REN)            
$169
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$142
MED / NON / CHILD(REN)            
$253
NON / MED / CHILD(REN)            
$247
NON / NON / CHILD(REN)            
$253
CHILD(REN)  
CHILD(REN)            
$13
   
BORN BEFORE 01/01/1909, Retiree pays no more than the amount as of June 1, 2003
ANNUITANT  
MEDICARE            
$18 OR $8
NON-MEDICARE            
$55
ANNUITANT AND SPOUSE  
MEDICARE / MEDICARE            
$ 42 OR $ 41
MEDICARE / NON-MEDICARE            
$ 76
NON-MEDICARE / MEDICARE            
$ 76
NON-MEDICARE / NON-MEDICARE            
$ 110