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Retiree Insurance
2009 Insurance Rates

CONTENTS

Life Insurance Self-Pay Rate for subscribers is $2.19 per month.

Premiums may be automatically deducted from the PERS, TRS, or LEOFF Subscriber benefit checks.
UW Retirement Plan (UWRP) subscribers may make arrangements for automatic deduction from a bank account.

Medical Rates (without Medicare)

  Subscriber Subscriber+
Spouse/QDP		 Subscriber +
Child(ren)		 Full Family
Aetna Public Employees Plan $513.44 $1,020.79 $893.95 $1,401.30
Group Health Classic 508.50 1,010.91 885.31 1,387.72
Group Health Value 426.16 846.23 741.21 1,161.28
Kaiser Permanente Classic 476.60 947.11 829.48 1,299.99
Kaiser Permanente Value 433.88 861.67 754.72 1,182.51
Uniform Medical Plan PPO 427.25 848.41 743.12 1,164.28

Medical Rates (with Medicare)

  Subscriber
Only 		Subscriber+
Spouse/ QDP
(1 elig)		 Subscriber+
Spouse/QDP
(2 elig)		 Subscriber+
Child(ren)
(2 elig)		 Subscriber+
Child(ren)

 Full Family
(1 elig)		 Full Family
(2 elig)		 Full Family
(3 elig)
Aetna Public Employees Plan $202.28 $709.63 $398.47 $398.47 $582.79 $1,090.14 $778.98 $594.66
Group Health Classic 142.31 644.72 278.53 278.53 519.12 1,021.53 655.34 414.75
Group Health Value 126.81 546.88 247.53 247.53 441.86 861.93 562.58 368.25
Kaiser Permanente Classic 171.31 641.82 336.53 336.53 524.19 994.70 689.41 501.75
Kaiser Permanente Value 139.04 566.83 271.99 271.99 459.88 887.67 592.83 404.94
Secure Horizons Classic* 186.16 n/a 366.23 366.23 n/a n/a n/a 546.30
Secure Horizons Value* 144.58 n/a 283.07 283.07 n/a n/a n/a 421.56
Uniform Medical Plan 170.02 591.18 333.95 333.95 485.89 907.05 649.82 497.88

Dental Rates With Medical

  Subscriber
Only		 Subscriber+
Spouse/QDP		 Subscriber+
&Child(ren)		 Full Family
DeltaCare, administered by Washington Dental Service $37.19 $74.38 $74.38 $111.57
Willamette Dental 37.03 74.06 74.06 111.09
Uniform Dental Plan 41.69 83.38 83.38 125.07

Medicare Supplement Plans (administered by Premera Blue Cross)

  Subscriber
Only 		*Subscriber+ Spouse
/QDP
(1 elig)		 Subscriber+ Spouse
/QDP
(2 elig, 1 dis)		 Subscriber+ Spouse
/QDP
(2 elig)		 *Subscriber+ Child(ren)
 *Full Family
(1 elig)		 *Full Family (2 elig, 1 dis) *Full Family
(2 elig)
Plan E Retired $72.21 $493.37 $184.61 $138.33 $388.08 $809.24 $500.48 $454.20
Plan E Disabled 118.49 539.65 184.61 230.89 434.36 855.52 500.48 546.76
Plan J Retired without Rx 101.62 522.78 264.02 197.15 417.49 838.65 579.89 513.02
Plan J Disabled without Rx 168.49 589.65 264.02 330.89 484.36 905.52 579.89 646.76
Plan J Retired with Rx** 141.52 562.68 419.11 276.95 457.39 878.55 734.98 592.82
Plan J Disabled with Rx** 283.68 704.84 419.11 561.27 599.55 1,020.71 734.98 877.14

*If a Medicare supplement plan is selected, non-Medicare eligible dependents are enrolled in the Uniform Medical Plan Preferred Provider Organization (UMP PPO). The rates shown reflect the total rate due, including both the Medicare supplement and UMP PPO premiums.

**Plan J with Rx is no longer offered to new subscribers.

QDP = Qualified Domestic Partner

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