Monthly Premiums for Medicare Eligible Members
Plan Year January 1, 2012 - December 31, 2012
| MEDICARE SUPPLEMENT PLANS | ||||
| HealthChoice Employer PDP High Option With Part D | $332.54 per enrolled person | |||
| HealthChoice Employer PDP Low Option With Part D | $273.02 per enrolled person | |||
| HealthChoice High Option Without Part D | $383.34 per enrolled person | |||
| HealthChoice Low Option Without Part D | $323.82 per enrolled person | |||
| UnitedHealthcare Senior Supplement High Option | $398.76 per enrolled person | |||
| UnitedHealthcare Senior Supplement Low Option | $357.63 per enrolled person | |||
| MEDICARE ADVANTAGE PRESCRIPTION DRUG PLANS (MA-PD) | ||||
| CommunityCare Senior | $230.00 per enrolled person | |||
| Generations HealthCare | $191.95 per enrolled person | |||
| UnitedHealthcare Group Medicare Advantage | $243.65 per enrolled person | |||
| 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 (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 (PVCS) | $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 | From $5,000 to $40,000 | $1.88 Per $1,000 Unit | ||
|
Age Rated Life – Cost Per $1,000 from $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 | |||
These rates do not reflect any contribution from your retirement system.
Last Modified on 01/11/2012