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Retiree Insurance
2007 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
Community Health Plan Classic $471.32 $935.41 $819.39 $1,283.48
Group Health Classic 427.37 847.51 742.48 1,162.62
Group Health Value 383.15 759.07 665.09 1,041.01
Kaiser Permanente Classic 439.92 872.61 764.44 1,197.13
Kaiser Permanente Value 401.10 794.97 696.50 1,090.37
Regence BlueShield Classic 508.80 1,010.37 884.98 1,386.55
Uniform Medical Plan PPO 393.78 780.33 683.69 1,070.24

Medical Rates (with Medicare)

  Subscriber
Only 		Subscriber+ Spouse/
QDP
(1 elig)		 Subscriber+ Spouse/
QDP
(2 elig)		 Subscriber+
Child(ren)
(1 elig)		 Subscriber+
Child(ren)
(2 elig)
 Full Family
(1 elig)		 Full Family
(2 elig)		 Full Family
(3 elig)
Community Health Plan Classic $281.72 $745.81 $556.21 $629.79 $556.21 $1,093.88 $904.28 $830.70
Group Health Classic 179.45 599.59 351.67 494.56 351.67 914.70 666.78 523.89
Group Health Value 152.15 528.07 297.07 434.09 297.07 810.01 579.01 441.99
Kaiser Permanente Classic 157.00 589.69 306.77 481.52 306.77 914.21 631.29 456.54
Kaiser Permanente Value 121.16 515.03 235.09 416.56 235.09 810.43 530.49 349.02
Regence Classic 360.29 861.86 713.35 736.47 713.35 1,238.04 1,089.53 1,066.41
Secure Horizons Classic* 175.51 n/a 343.79 n/a 343.79 n/a n/a 512.07
Secure Horizons Value* 128.41 n/a 249.59 n/a 249.59 n/a n/a 370.77
Uniform Medical Plan 186.33 572.88 365.43 476.24 365.43 862.79 655.34 544.53

Dental Rates With Medical

  Subscriber
Only		 Subscriber+
Spouse/QDP		 Subscriber+
&Child(ren)		 Full Family
DeltaCare, administered by Washington Dental Service $33.36 $66.72 $66.72 $100.08
Regence BlueShield administered by Columbia Dental Plan 45.63 91.26 91.26 136.89
Uniform Dental Plan 38.59 77.18 77.18 115.77

Medicare Supplement Plans (administered by Premera Blue Cross)

  Subscriber
Only 		*Subscriber+ Spouse
/QDP
(1 elig)		 Subscriber+ Spouse
/QDP
(2 elig - 1 med,
1 dis)		 Subscriber+ Spouse
/QDP
(2 elig)		 *Subscriber+ Child(ren)
(1 elig) 		*Full Family
(1 elig)		 *Full Family (2 elig - 1 med, 1 dis) *Full Family
(3 elig)
Plan E Retired $68.29 $454.84 $172.09 $129.35 $358.20 $744.75 $462.00 $419.26
Plan E Disabled 111.03 497.58 172.09 214.83 400.94 787.49 462.00 504.74
Plan J Retired without Rx 88.93 475.48 227.81 170.63 378.84 765.39 517.72 460.54
Plan J Disabled without Rx 146.11 532.66 227.81 284.99 436.02 822.57 517.72 574.90
Plan J Retired with Rx** 143.84 530.39 458.64 280.45 433.75 820.30 748.55 570.36
Plan J Disabled with Rx** 322.03 708.58 458.64 636.83 611.94 998.49 748.55 926.74

*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

Retiree Insurance Topics