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Public Employees' Benefits Program (PEBP) - Hometown Health

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Non-State Active Rates<br />

Effective November 1, 2009 - June 30, 2010<br />

Self-funded PPO Plan Rate Supplemental<br />

Subsidy<br />

Employee<br />

Premium<br />

Employee Only $ 782.53 $ - $ 782.53<br />

Employee + Spouse $ 1,472.34 $ 34.89 $ 1,437.45<br />

Employee + Child(ren) $ 721.02 $ - $ 721.02<br />

Employee + Family $ 1,294.00 $ 88.69 $ 1,205.31<br />

<strong>Health</strong> Plan of Nevada<br />

Southern Nevada HMO<br />

Rate<br />

Supplemental<br />

Subsidy<br />

Employee<br />

Premium<br />

Employee Only $ 367.04 $ - $ 367.04<br />

Employee + Spouse $ 700.04 $ - $ 700.04<br />

Employee + Child(ren) $ 594.62 $ - $ 594.62<br />

Employee + Family $ 918.95 $ - $ 918.95<br />

<strong>Hometown</strong> <strong>Health</strong> Plan<br />

Northern Nevada HMO<br />

Rate<br />

Supplemental<br />

Subsidy<br />

Employee<br />

Premium<br />

Employee Only $ 657.74 $ - $ 657.74<br />

Employee + Spouse $ 1,428.37 $ - $ 1,428.37<br />

Employee + Child(ren) $ 864.57 $ - $ 864.57<br />

Employee + Family $ 1,450.43 $ - $ 1,450.43<br />

9

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