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STATE OF CONNECTICUT

TEACHERS’ RETIREMENT BOARD

765 ASYLUM AVENUE HARTFORD, CT 06105-2822

Toll free 1-800-504-1102  (860) 241-8400   Fax (860) 241-9295

“An Affirmative Action/Equal Opportunity Employer”

www.ct.gov/trb

September 16, 2009

MEDICARE SUPPLEMENTAL HEALTH PLAN

PREMIUM CHANGE ANNOUNCEMENT FOR 2010

The Board adopted premiums for the Teachers’ Retirement Board sponsored self-insured Medicare supplemental health plan for coverage effective January 1, 2010 as follows:

                                                Cost = Per Member Per Month