Monthly Premiums for Former Employees and Surviving Dependents
Plan Year January 1, 2012 - December 31, 2012
| HEALTH PLANS | MEMBER | SPOUSE | CHILD | CHILDREN |
| HealthChoice High | $ 449.48 | $ 668.10 | $ 228.20 | $ 352.08 |
| HealthChoice High Alternative | $ 449.48 | $ 668.10 | $ 228.20 | $ 352.08 |
| HealthChoice Basic | $ 391.64 | $ 571.84 | $ 201.82 | $ 310.80 |
| HealthChoice Basic Alternative | $ 391.64 | $ 571.84 | $ 201.82 | $ 310.80 |
| HealthChoice S-Account | $ 382.56 | $ 542.52 | $ 190.18 | $ 291.90 |
| HealthChoice USA | $ 688.82 | $ 688.82 | $ 226.22 | $ 348.86 |
| CommunityCare Standard HMO | $ 803.22 | $1,148.58 | $ 401.60 | $ 642.56 |
| CommunityCare Alternative HMO | $ 553.96 | $ 792.14 | $ 276.98 | $ 443.16 |
| CommunityCare Wellness Alternative Plus HMO | $ 528.96 | $ 792.14 | $ 276.98 | $ 443.16 |
| GlobalHealth Standard HMO | $ 402.84 | $ 660.72 | $ 212.27 | $ 338.44 |
| GlobalHealth Alternative HMO | $ 366.24 | $ 600.68 | $ 193.00 | $ 307.70 |
| GlobalHealth Wellness Alternative Plus HMO | $ 341.24 | $ 600.68 | $ 193.00 | $ 307.70 |
| UnitedHealthcare Standard HMO | $ 768.80 | $1,105.36 | $ 384.12 | $ 614.72 |
| UnitedHealthcare Alternative HMO | $ 530.20 | $ 762.32 | $ 264.90 | $ 423.94 |
| UnitedHealthcare Wellness Alternative Plus HMO | $ 505.20 | $ 762.32 | $ 264.90 | $ 423.94 |
| DENTAL PLANS | MEMBER | SPOUSE | CHILD | CHILDREN |
| HealthChoice Dental | $30.20 | $30.20 | $25.18 | $65.32 |
| 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 | $33.64 | $33.62 | $29.26 | $74.04 |
| Delta Dental Premier | $38.36 | $38.36 | $33.38 | $84.46 |
| Delta Dental PPO - Choice | $15.06 | $34.18 | $34.44 | $83.60 |
| VISION PLANS | 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 Plan | $ 7.14 | $ 7.10 | $ 6.72 | $13.80 |
| 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 | $1.88 Per $1,000 | |
| Age-Rated Supplemental Life – Cost Per $1,000 for $41,000 and Up | ||
| < 30 ----------- $0.03 | 45 - 49 ------- $0.10 | 65 - 69 ------- $0.51 |
| 30 - 34 ------- $0.03 | 50 - 54 ------- $0.17 | 70 - 74 ------- $0.87 |
| 35 - 39 ------- $0.04 | 55 - 59 ------- $0.27 | 75+ ----------- $1.35 |
| 40 - 44 ------- $0.06 | 60 - 64 ------- $0.31 | |
| DEPENDENT LIFE | $0.94 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 of coverage | $10,000 of coverage | $20,000 of coverage |
| Child (age 6 months to 26) | $3,000 of coverage | $ 5,000 of coverage | $10,000 of coverage |
| Child (live birth to 6 months) | $1,000 of coverage | $ 1,000 of coverage | $ 1,000 of coverage |
| SURVIVING DEPENDENTS OF FORMER EMPLOYEES |
$0.94 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 08/30/2011