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Retiree Insurance
2012 Insurance Rates

CONTENTS

Monthly premiums may be automatically deducted from the PERS, TRS, or LEOFF subscriber benefit checks. UW Retirement Plan (UWRP) subscribers may make arrangements for monthly automatic deduction from a bank account. Download Electronic Debit form.

Life Insurance

The life insurance self-pay rate for subscribers is $6.57 per month.

Monthly Medical Rates (without Medicare)

Classic & Value Plans

Members not eligible for Medicare (or enrolled in Part A only):
Uniform Medical Plan Classic Group Health Classic Group Health Value Kaiser Permanente Classic
Subscriber
$531.11
$550.48
$501.58
$538.18
Subscriber & Spouse/QDP
1,056.69
1,095.43
997.63
1,070.83
Subscriber & Child(ren)
925.30
959.19
873.62
937.67
Full Family
1,450.88
1,504.14
1,369.67
1,470.32

Consumer-Driven Health Plan with Health Savings Account (CDHP/HSA)

Members not eligible for Medicare (or enrolled in Part A only):
Uniform Medical CDHP/HSA Group Health CDHP/HSA Kaiser Permanente CDHP/HSA
Subscriber
$485.22
$482.92
$481.27
Subscriber & Spouse/QDP*
961.45
957.35
953.55
Subscriber & Child(ren)*
856.97
853.32
850.06
Full Family*
1,274.87
1,269.42
1,264.01

Monthly Medical Rates (with Medicare)

Members enrolled in Part A & B of Medicare: # Medicare Eligible Uniform Medical Plan Classic Group Health Medicare Plan Group Health Classic Group Health Value Kaiser Permanente Classic
Subscriber Only
$213.87
$131.86
N/A*
N/A*
$149.23
Subscriber & Spouse/QDP
1
739.45
N/A*
$676.81
$627.91
681.88
Subscriber & Spouse/QDP
2
422.21
258.19
N/A*
N/A*
292.93
Subscriber & Child(ren)
1
608.06
N/A*
540.57
503.90
548.72
Subscriber & Child(ren)
2
422.21
258.19
N/A*
N/A*
292.93
Full Family
1
1,133.64
N/A*
1,085.52
999.95
1,081.37
Full Family
2
816.40
N/A*
666.90
630.23
692.42
Full Family
3
630.55
384.52
N/A*
N/A*
436.63

*If a Group Health subscriber is enrolled in Medicare Part A and Part B but covers a family member not eligible for Medicare, the family member must enroll in a Group Health Classic or Value plan and the subscriber pays a combined Medicare and non-Medicare rate.

Note: Medicare rates shown above have been reduced by the state-funded contribution up to the lesser of $150 or 50 percent of plan premium per retiree per month.

Monthly Dental Rates With Medical*

  Uniform Dental Plan** DeltaCare** Willamette Dental
Subscriber Only
$45.20
$39.53
$42.68
Subscriber & Spouse/QDP
90.40
79.06
85.36
Subscriber & Child(ren)
90.40
79.06
85.36
Full Family
135.60
118.59
128.04

**Uniform Dental Plan and the DeltaCare Plan are administered by Washington Dental Service.

Premera Blue Cross Medicare Supplement Plans

Monthly rates # Medicare Eligible #Disabled

Plan F
(Age 65 or older, eligible by age)

Plan F
(Under age 65, eligible by disability)

Subscriber Only
$99.77
$175.93
*Subscriber & Spouse /QDP
1
625.35
701.51
Subscriber & Spouse/QDP
2
1
270.17
270.17
Subscriber & Spouse/QDP
2
194.01
346.33
*Subscriber & Child(ren)
493.96
570.12
*Full Family
1
1,019.54
1,095.70
*Full Family
2
1
664.36
664.36
*Full Family
2
588.20
740.52

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

Medicare rates shown above have been reduced by the state-funded contribution up to the lesser of $150 or 50 percent of plan premium per retiree per month.

QDP = Qualified Domestic Partner

Retiree Insurance Topics