CITY OF CHICAGO
MONTHLY RATES FOR ANNUITANT HEALTHCARE PLANS
EFFECTIVE DATE - JULY 1, 2011

CATEGORY
PLAN
2011 ANNUITANT
CONTRIBUTION RATES
RETIRED ON / AFTER 07/01/2005  WITH 20 YEARS OF SERVICE  
                                                                                   (City Share at 50%)
ANNUITANT  
MEDICARE            
$84
NON-MEDICARE            
$364
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$226
MEDICARE / NON-MEDICARE           
$536
NON-MEDICARE / MEDICARE            
$506
NON-MEDICARE NON-MEDICARE             
$805
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$211
NON-MEDICARE / CHILD(REN)            
$481
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$353
MED / NON / CHILD(REN)            
$653
NON / MED / CHILD(REN)            
$623
NON / NON / CHILD(REN)            
$922
CHILD(REN)  
CHILD(REN)            
$  26
     

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

ANNUITANT  
MEDICARE            
$99
NON-MEDICARE            
$410
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$255
MEDICARE / NON-MEDICARE           
$596
NON-MEDICARE / MEDICARE            
$566
NON-MEDICARE NON-MEDICARE             
$895
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$239
NON-MEDICARE / CHILD(REN)            
$538
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$395
MED / NON / CHILD(REN)            
$724
NON / MED / CHILD(REN)            
$694
NON / NON / CHILD(REN)            
$1,024
CHILD(REN)  
CHILD(REN)            
$  53
     

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

ANNUITANT  
MEDICARE            
$114
NON-MEDICARE            
$456
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$284
MEDICARE / NON-MEDICARE           
$656
NON-MEDICARE / MEDICARE            
$626
NON-MEDICARE NON-MEDICARE             
$985
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$266
NON-MEDICARE / CHILD(REN)            
$596
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$437
MED / NON / CHILD(REN)            
$796
NON / MED / CHILD(REN)            
$766
NON / NON / CHILD(REN)            
$1,125
CHILD(REN)  
CHILD(REN)            
$66
   

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

ANNUITANT  
MEDICARE            
$233
NON-MEDICARE            
$823
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$517
MEDICARE / NON-MEDICARE           
$1,137
NON-MEDICARE / MEDICARE            
$1,107
NON-MEDICARE NON-MEDICARE             
$1,706
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$487
NON-MEDICARE / CHILD(REN)            
$1,056
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$771
MED / NON / CHILD(REN)            
$1,307
NON / MED / CHILD(REN)            
$1,340
NON / NON / CHILD(REN)            
$1,939
CHILD(REN)  
CHILD(REN)            
$173
   
   
RETIRED ON / AFTER 08/23/1989 and BEFORE 07/01/2005    (City Share at 55%)
ANNUITANT  
MEDICARE            
$69
NON-MEDICARE            
$318
ANNUITANT AND SPOUSE            
MEDICARE / MEDICARE            
$197
MEDICARE / NON-MEDICARE           
$476
NON-MEDICARE / MEDICARE            
$446
NON-MEDICARE NON-MEDICARE             
$715
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$184
NON-MEDICARE / CHILD(REN)            
$423
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$311
MED / NON / CHILD(REN)            
$581
NON / MED / CHILD(REN)            
$551
NON / NON / CHILD(REN)            
$820
CHILD(REN)  
CHILD(REN)            
$  26
     
RETIRED BEFORE 08/23/1989:    
ANNUITANT    

MEDICARE            

$69
NON-MEDICARE            
$69
ANNUITANT AND SPOUSE  
MEDICARE / MEDICARE            
$197
MEDICARE / NON-MEDICARE            
$197
NON-MEDICARE / MEDICARE             
$197
NON-MEDICARE NON-MEDICARE           
$197
ANNUITANT AND CHILD(REN)  
MEDICARE / CHILD(REN)            
$184
NON-MEDICARE / CHILD(REN)            
$184
ANNUITANT, SPOUSE AND CHILD(REN)
MED / MED / CHILD(REN)            
$311
MED / NON / CHILD(REN)           
$311
NON / MED / CHILD(REN)           
$311
NON / NON / CHILD(REN)           
$311
CHILD(REN)  
CHILDREN            
$ 26
   
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)            
$26
   
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