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Retiree Insurance
2010 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)

Members not eligible for Medicare
(or enrolled in Part A only):
Subscriber Subscriber+
Spouse/QDP		 Subscriber +
Child(ren)		 Full Family
$531.44 $1,056.44 $925.19 $1,450.19
470.73 935.02 818.95 1,283.24
421.44 836.44 732.69 1,147.69
471.51 936.58 820.31 1,285.38
441.08 875.72 767.06 1,201.70
440.20 873.96 765.52 1,199.28

Medical Rates (with Medicare)

Members enrolled in Part A & B of 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)
$277.38 $802.38 $548.32 $671.13 $548.32 $1,196.13 $942.07 $819.26
132.36 596.65 258.28 480.58 258.28 944.87 606.50 384.20
124.44 539.44 242.44 435.69 242.44 850.69 553.69 360.44
166.40 631.47 326.36 515.20 326.36 980.27 675.16 486.32
135.44 570.08 264.44 461.42 264.44 896.06 590.42 393.44
210.70 n/a 414.96 n/a 414.96 n/a n/a 619.22
127.02 n/a 247.60 n/a 247.60 n/a n/a 368.18
162.86 596.62 319.28 488.18 319.28 921.94 644.60 475.70

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
40.18 80.36 80.36 120.54
44.53 89.06 89.06 133.59

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)
(1 elig)
*Full Family
(1 elig)		 *Full Family (2 elig, 1 dis) *Full Family
(2 elig)
Plan E Retired
 $72.56 $506.32 $184.96 $138.68 $397.88 $831.64 $510.28 $464.00
Plan E Disabled
 118.84 552.60 184.96 231.24 444.16 877.92 510.28 556.56
Plan J Retired with Rx**
 141.87 575.63 419.46 277.30 467.19 900.95 744.78 602.62
Plan J Disabled with Rx**
 284.03 717.79 419.46 561.62 609.35 1,043.11 744.78 886.94
Plan J Retired without Rx
 101.97 535.73 264.37 197.50 427.29 861.05 589.69 522.82
Plan J Disabled without Rx
 168.84 602.60 264.37 331.24 494.16 927.92 589.69 656.56

*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 premiums for both plans.

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

QDP = Qualified Domestic Partner

Retiree Insurance Topics