|
2011 Medical Premium Rates
|
|
|
|
|
|
Article Content
 |
| Employee Medical Rates |
|
View as a PDF
|
2011 Employee Medical Plan Monthly Premium Rates
|
| | Employee | Employee & Spouse/Partner | Employee & Children | Employee & Family |
| PEBB Statewide PPO1 | $991.84 | $1,328.92 | $1,140.54 | $1,358.67 |
| Providence Choice2 | 860.24 | 1,152.69 | 989.29 | 1,178.50 |
| Kaiser Permanente HMO3 | 892.93 | 1,196.52 | 1,026.89 | 1,223.32 |
| PEBB Statewide Part-time PPO4 | 793.82 | 1,063.62 | 912.85 | 1,087.45 |
| Providence Choice Part-time5 | 685.25 | 918.21 | 788.04 | 938.77 |
| Kaiser Permanente Part-time HMO6 | 755.91 | 1,012.92 | 869.29 | 1,035.59 |
1 Available to eligible full-time and part-time employees. VSP routine vision services.
2 Available to eligible full-time and part-time employees in plan service area. VSP routine vision services.
3 Available to eligible full-time and part-time employees in plan service area. Kaiser Permanente HMO routine vision services.
4 Additional option available to eligible part-time employees. No vision benefit.
5 Additional option available to eligible part-time employees in plan service area. No vision benefit.
6 Additional option available to eligible part-time employees in plan service area. Vision exam only.
|
|
|
| Retiree Medical Rates |
|
View as a PDF
| 2011 Retiree Medical Plan Monthly Premium Rates |
| | Retiree | Retiree & Spouse/Partner | Retiree & Children | Retiree & Family | Child(ren) Only7 |
| PEBB Statewide PPO1 | $997.71 | $1,336.78 | $1,147.29 | $1,366.71 | $511.35 |
| Providence Choice2 | 865.34 | 1,159.52 | 995.14 | 1,185.48 | 448.55 |
| Kaiser Permanente HMO3 | 898.26 | 1,203.67 | 1,033.03 | 1,230.63 | 458.10 |
| PEBB Statewide Part-time PPO4 | 798.52 | 1,069.91 | 918.26 | 1,093.89 | 411.06 |
| Providence Choice Part-time5 | 689.31 | 923.64 | 792.70 | 944.33 | 351.53 |
| Kaiser Permanente Part-time HMO6 | 760.43 | 1,018.97 | 874.49 | 1,041.77 | 387.81 |
1 Available to eligible retirees. VSP routine vision services.
2 Available to eligible retirees in plan service area. VSP routine vision services.
3 Available to eligible retirees in plan service area. Kaiser Permanente HMO routine vision services.
4 Additional option available to eligible retirees. No vision benefit.
5 Additional option available to eligible retirees in plan service area. No vision benefit.
6 Additional option available to eligible retirees in plan service area. Vision exam only.
7 Child(ren) Only coverage is available only to COBRA & Retiree participants.
|
|
|
| COBRA Medical Rates |
|
View as a PDF
|
2011 COBRA Participant Medical Plan Monthly Premium Rates
|
| | Self | Self & Spouse/Partner | Self & Children | Self & Family | Child(ren) Only7 |
| PEBB Statewide PPO1 | $1,011.41 | $1,355.13 | $1,163.04 | $1,385.47 | $518.36 |
| Providence Choice2 | 877.21 | 1,175.43 | 1,008.80 | 1,201.75 | 454.70 |
| Kaiser Permanente HMO3 | 910.71 | 1,220.35 | 1,047.35 | 1,247.69 | 464.45 |
| PEBB Statewide Part-time PPO4 | 809.48 | 1,084.59 | 930.86 | 1,108.90 | 416.70 |
| Providence Choice Part-time5 | 698.77 | 936.32 | 803.58 | 957.29 | 356.36 |
| Kaiser Permanente Part-time HMO6 | 770.97 | 1,033.09 | 886.61 | 1,056.22 | 393.19 |
1 Available to eligible individuals. VSP routine vision services.
2 Available to eligible individuals in plan service area. VSP routine vision services.
3 Available to eligible individuals in plan service area. Kaiser Permanente HMO routine vision services.
4 Additional option available to eligible individuals. No vision benefit.
5 Additional option available to eligible individuals in plan service area. No vision benefit.
6 Additional option available to eligible individuals in plan service area. Vision exam only.
7 Child(ren) Only coverage is available only to COBRA & Retiree participants.
|
|
|
| Self-pay Medical Rates |
|
View as a PDF
|
2011 Self-pay Participant Medical Plan Monthly Premium Rates
|
|
Self
|
Self & Spouse/Partner
|
Self & Children
|
Self & Family
|
PEBB Statewide PPO1
|
$1,002.14
|
$1,339.22
|
$1,150.84
|
$1,368.97
|
Providence Choice2
|
870.54
|
1,162.99
|
999.59
|
1,188.80
|
Kaiser Permanente HMO3
|
903.23
|
1,206.82
|
1,037.19
|
1,233.62
|
1 Available to eligible individuals. VSP routine vision services.
2 Available to eligible individuals in plan service area. VSP routine vision services.
3 Available to eligible individuals in plan service area. Kaiser Permanente HMO routine vision services.
|
|
|
| Medical Opt-out Calculations |
|
For medical-only opt out: From $233, subtract the monthly premium amount for your choice of at least employee-only dental coverage and $1 for the monthly premium amount for employee basic life. The result is an estimate of the amount that will be added to your taxable pay.
For combined medical and dental opt out: From $193.50, subtract $1 for the monthly premium amount for employee basic life. The result is an estimate of the amount that will be added to your taxable pay.
|
|
|
| Part-time Employee Worksheet |
|
View as a PDF
1.a Prorated monthly benefit amount based on hours worked compared with full-time
Select the coverage tier that applies to you. Multiply the Full-time Monthly Benefit Amount for the coverage tier you selected by the percentage of hours you work compared with full time. The result is an estimate of your Prorated Monthly Benefit Amount.
Coverage Tier
|
Full-time Monthly Monthly Benefit Amount
|
Times 50% Hours Worked = Monthly Benefit Amount
|
Times 80% Hours Worked = Monthly Benefit Amount
|
Employee only
|
$1,051.46
|
$525.73
|
$841.17
|
Employee & spouse/ domestic partner
|
$1,415.83
|
707.92
|
1132.66
|
Employee & children
|
$1,210.82
|
605.41
|
968.66
|
Employee & family
|
$1,446.19
|
723.10
|
1156.96
|
1.b Subsidy amount if you enroll in a PART-TIME MEDICAL PLAN
Next to your coverage tier, enter your Prorated Monthly Benefit Amount from the calculation above. Add the Subsidy for Part-time Plans for your coverage tier. The result is an estimate of your subsidized benefit amount if you enroll in a part-time plan.
Coverage Tier
|
A. Prorated Monthly Benefit Amount
|
B. Subsidy for Part-time Plan
|
A+B = Subsidized Monthly Benefit Amount
|
|
50% HW
|
80% HW
|
50% HW
|
80% HW
|
Employee only
|
$525.73
|
$841.17
|
$259.53
|
$785.26
|
$1100.70
|
Employee & spouse/ domestic partner
|
707.92
|
1132.66
|
$331.23
|
1039.15
|
1463.89
|
Employee & children
|
605.41
|
968.66
|
$295.30
|
900.71
|
1263.96
|
Employee & family
|
723.10
|
1156.96
|
$336.16
|
1059.26
|
1493.11
|
|
1.
| Enter the monthly benefit amount you calculated in 1.a or 1.b above.
| $______________
|
|
2.
| Enter $1.00 for mandatory basic life insurance.
| $______________
|
|
3.
| Enter your monthly medical premium cost.
| $______________
|
|
4.
| Enter your monthly dental premium cost. (You must have at least employee-only dental coverage. You may also cover dependents.)
| $______________
|
|
5.
| Enter the sum of 2 through 4. This is your monthly premium cost.
| $______________
|
|
6.
| Subtract line 5 from line 1. Subtract line 5 from line 1. A negative result equals the estimated monthly payroll deduction for your medical, dental and basic life coverage. A positive result means that your premium cost is 0.
| $______________
|
|
|
|
| Examples of Estimating Part-time Employee Premium |
|
|
Examples
These examples show estimated premium costs for part-time employees working a given percentage of hours compared with full time. In no case will the monthly benefit amount plus subsidy exceed the cost of premiums for core benefits.
|
2011 Part-time Providence Choice with Part-time ODS Dental
|
|
50% Contribution (works 50% of full time)
|
80% Contribution (works 80% of full time)
|
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Subsidized Contribution
|
744.60
|
997.40
|
856.15
|
1,019.72
|
744.60
|
997.40
|
856.15
|
1,019.72
|
Medical Rate
|
685.25
|
918.21
|
788.04
|
938.77
|
685.25
|
918.21
|
788.04
|
938.77
|
Dental Rate
|
58.35
|
78.19
|
67.11
|
79.95
|
58.35
|
78.19
|
67.11
|
79.95
|
Basic Life
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
Total Rate
|
744.60
|
997.40
|
856.15
|
1,019.72
|
744.60
|
997.40
|
856.15
|
1,019.72
|
Employee Balance
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
|
|
|
|
|
|
|
|
|
|
2011 Part-time PEBB Statewide PPO with Part-time ODS Dental
|
|
50% Contribution (works 50% of full time)
|
80% Contribution (works 80% of full time)
|
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Subsidized Contribution
|
785.26
|
1,039.15
|
900.71
|
1,059.26
|
853.17
|
1,142.81
|
980.96
|
1,168.40
|
Medical Rate
|
793.82
|
1,063.62
|
912.85
|
1,087.45
|
793.82
|
1,063.62
|
912.85
|
1,087.45
|
Dental Rate
|
58.35
|
78.19
|
67.11
|
79.95
|
58.35
|
78.19
|
67.11
|
79.95
|
Basic Life
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
Total Rate
|
853.17
|
1,142.81
|
980.96
|
1,168.40
|
853.17
|
1,142.81
|
980.96
|
1,168.40
|
Employee Balance
|
-67.91
|
-103.66
|
-80.25
|
-109.14
|
0.00
|
0.00
|
0.00
|
0.00
|
|
|
|
|
|
|
|
|
|
|
2011 Part-time Kaiser Permanente HMO with Part-time ODS Dental
|
|
50% Contribution (works 50% of full time)
|
80% Contribution (works 80% of full time)
|
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Subsidized Contribution
|
785.26
|
1,039.15
|
900.71
|
1,059.26
|
815.26
|
1,092.11
|
937.40
|
1,116.54
|
Medical Rate
|
755.91
|
1,012.92
|
869.29
|
1,035.59
|
755.91
|
1,012.92
|
869.29
|
1,035.59
|
Dental Rate
|
58.35
|
78.19
|
67.11
|
79.95
|
58.35
|
78.19
|
67.11
|
79.95
|
Basic Life
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
Total Rate
|
815.26
|
1,092.11
|
937.40
|
1,116.54
|
815.26
|
1,092.11
|
937.40
|
1,116.54
|
Employee Balance
|
-30.00
|
-52.96
|
-36.69
|
-57.28
|
0.00
|
0.00
|
0.00
|
0.00
|
|
2011 Part-time Providence Choice with Part-time Kaiser Dental
|
|
50% Contribution (works 50% of full time)
|
80% Contribution (works 80% of full time)
|
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Subsidized Contribution
|
740.90
|
992.43
|
851.89
|
1,014.65
|
740.90
|
992.43
|
851.89
|
1,014.65
|
Medical Rate
|
685.25
|
918.21
|
788.04
|
938.77
|
685.25
|
918.21
|
788.04
|
938.77
|
Dental Rate
|
54.65
|
73.22
|
62.85
|
74.88
|
54.65
|
73.22
|
62.85
|
74.88
|
Basic Life
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
Total Rate
|
740.90
|
992.43
|
851.89
|
1,014.65
|
740.90
|
992.43
|
851.89
|
1,014.65
|
Employee Balance
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
0.00
|
|
|
|
|
|
|
|
|
|
|
2011 Part-time PEBB Statewide PPO with Part-time Kaiser Dental
|
|
50% Contribution (works 50% of full time)
|
80% Contribution (works 80% of full time)
|
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Subsidized Contribution
|
785.26
|
1,039.15
|
900.71
|
1,059.26
|
849.47
|
1,137.84
|
976.70
|
1,163.33
|
Medical Rate
|
793.82
|
1,063.62
|
912.85
|
1,087.45
|
793.82
|
1,063.62
|
912.85
|
1,087.45
|
Dental Rate
|
54.65
|
73.22
|
62.85
|
74.88
|
54.65
|
73.22
|
62.85
|
74.88
|
Basic Life
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
Total Rate
|
849.47
|
1,137.84
|
976.70
|
1,163.33
|
849.47
|
1,137.84
|
976.70
|
1,163.33
|
Employee Balance
|
-64.21
|
-98.69
|
-75.99
|
-104.07
|
0.00
|
0.00
|
0.00
|
0.00
|
|
|
|
2011 Part-time Kaiser Permanente HMO with Part-time Kaiser Dental
|
|
50% Contribution (works 50% of full time)
|
80% Contribution (works 80% of full time)
|
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Employee
|
Employee, Spouse/Partner
|
Employee, Child(ren)
|
Employee, Family
|
Subsidized Contribution
|
785.26
|
1,039.15
|
900.71
|
1,059.26
|
811.56
|
1,087.14
|
933.14
|
1,111.47
|
Medical Rate
|
755.91
|
1,012.92
|
869.29
|
1,035.59
|
755.91
|
1,012.92
|
869.29
|
1,035.59
|
Dental Rate
|
54.65
|
73.22
|
62.85
|
74.88
|
54.65
|
73.22
|
62.85
|
74.88
|
Basic Life
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
1.00
|
Total Rate
|
811.56
|
1,087.14
|
933.14
|
1,111.47
|
811.56
|
1,087.14
|
933.14
|
1,111.47
|
Employee Balance
|
-26.30
|
-47.99
|
-32.43
|
-52.21
|
0.00
|
0.00
|
0.00
|
0.00
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|