Monthly Premiums for Former Employees and Surviving Dependents
Plan Year January 1, 2011 - December 31, 2011
| HEALTH PLANS | MEMBER | SPOUSE | CHILD | CHILDREN |
| HealthChoice High Option | $ 449.48 | $ 682.74 | $ 228.20 | $ 352.08 |
| HealthChoice Basic | $ 391.64 | $ 598.48 | $ 201.82 | $ 310.80 |
| HealthChoice S-Account | $ 382.56 | $ 562.74 | $ 190.18 | $ 291.90 |
| HealthChoice USA | $ 688.82 | $ 688.82 | $ 226.22 | $ 348.86 |
| CommunityCare Standard HMO | $ 772.34 | $ 1,104.42 | $ 386.16 | $ 617.86 |
| CommunityCare Alternative HMO | $ 532.66 | $ 761.68 | $ 266.34 | $ 426.12 |
| GlobalHealth Standard HMO | $ 366.56 | $ 601.22 | $ 193.12 | $ 307.96 |
| GlobalHealth Alternative HMO | $ 333.26 | $ 546.58 | $ 175.62 | $ 279.98 |
| PacifiCare Standard HMO | $ 686.42 | $ 986.94 | $ 342.96 | $ 548.86 |
| PacifiCare Alternative HMO | $ 473.39 | $ 680.63 | $ 236.51 | $ 378.51 |
| DENTAL PLANS | MEMBER | SPOUSE | CHILD | CHILDREN |
| HealthChoice Dental | $29.84 | $29.84 | $24.88 | $64.56 |
| Assurant Freedom Preferred | $28.83 | $28.67 | $21.50 | $57.80 |
| Assurant Heritage Plus with SBA (Prepaid) | $11.74 | $ 8.86 | $ 7.60 | $15.20 |
| Assurant Heritage Secure (Prepaid) | $ 7.20 | $ 5.98 | $ 5.20 | $10.38 |
| CIGNA Dental Care Plan (Prepaid) | $ 9.26 | $ 6.06 | $ 7.08 | $15.32 |
| Delta Dental PPO | $31.14 | $31.14 | $27.10 | $68.56 |
| Delta Dental Premier | $35.52 | $35.52 | $30.90 | $78.20 |
| Delta Dental PPO - Choice | $13.94 | $31.64 | $31.90 | $77.42 |
| VISION PLANS - Employee Paid | MEMBER | SPOUSE | CHILD | CHILDREN |
| Humana/CompBenefits VisionCare Plan | $6.76 | $5.06 | $3.57 | $ 4.46 |
| Primary Vision Care Services | $9.25 | $8.00 | $8.50 | $10.75 |
| Superior Vision Services | $6.98 | $6.90 | $6.60 | $ 6.60 |
| UnitedHealthcare Vision | $8.18 | $5.79 | $4.59 | $ 6.98 |
| Vision Service Plan (VSP) | $8.76 | $5.87 | $5.62 | $12.64 |
| LIFE PLAN | PRE-MEDICARE RETIREE/VESTS | |||
| From $5,000 to $40,000 | $1.94 Per $1,000 | |||
| Age-Rated Supplemental Life Cost Per $1,000 for $41,000 and Up | ||||
| < 30 ---------- $0.05 | 45 - 49 -------- $0.19 | 65 - 69 -------- $0.99 | ||
| 30 - 34 ------- $0.05 | 50 - 54 -------- $0.32 | 70 - 74 -------- $1.67 | ||
| 35 - 39 ------- $0.08 | 55 - 59 - ------- $0.52 | 75+ -------------- $2.60 | ||
| 40 - 44 ------- $0.12 | 60 - 64 -------- $0.60 | |||
| DEPENDENT LIFE | $0.97 Per $500 Unit, Per Dependent | |||
| Monthly Life Insurance Premiums for Surviving Dependents | |||
| SURVIVING DEPENDENTS OF CURRENT EMPLOYEES | LOW OPTION $2.60 |
STANDARD OPTION $4.32 |
PREMIER OPTION $8.64 |
| Spouse | $6,000 | $10,000 | $20,000 |
| Child (age 6 months to 26) | $3,000 | $ 5,000 | $10,000 |
| Child (live birth to 6 months) | $1,000 | $ 1,000 | $ 1,000 |
| SURVIVING DEPENDENTS OF FORMER EMPLOYEES |
$0.97 Per $500 Unit, Per Dependent | ||
Rates do not reflect any retirement system contribution
By law, the premiums for current employees and pre-Medicare former employees must be the same. For information on how this reduces your premium, see the Frequently Asked Questions section of this website and search for blended rates.
Last Modified on 06/02/2011