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2012 Medical Plan Premium Rates
Employee Rates
 
Employees
Employee & Spouse/Partner
Employee & Children
Employee & Family
PEBB Statewide PPO1
$990.52
$1,327.15
$1,139.02
$1,356.87
Providence Choice2
870.22
1,166.06
1,000.76
1,192.18
Kaiser3
983.01
1,317.23
1,130.49
1,346.73
Kaiser Deductible3
903.83
1,211.11
1,039.40
1,238.24
PEBB Statewide Part-time PPO4
793.10
1,062.66
912.03
1,086.46
Providence Choice Part-time5
693.57
929.36
797.61
950.17
Kaiser Part-time6
832.18
1,115.10
957.00
1,140.06
Kaiser Deductible Part-Time6
785.96
1,053.18
903.87
1,076.76
1 Available to PEBB eligible full-time and part-time employees. VSP routine vision services.
2 Available to PEBB eligible full-time and part-time employees in plan service area. VSP routine vision services.
3 Available to PEBB eligible full-time and part-time employees in plan service area. Kaiser 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 Rates
 
 
Retiree
Retiree & Spouse/Partner
Retiree & Children
Retiree & Family
PEBB Statewide PPO1
$983.37
$1,317.58
$1,130.80
$1,347.08
Providence Choice2
863.80
1,157.46
993.37
1,183.38
Kaiser3
975.97
1,307.80
1,122.39
1,337.09
Kaiser Deductible3
897.35
1,202.44
1,031.96
1,229.37
PEBB Statewide Part-Time PPO4
787.38
1,054.99
905.45
1,078.62
Providence Choice Part-Time5
688.57
922.65
791.85
943.31
Kaiser Part-Time6
826.22
1,107.12
950.15
1,131.90
Kaiser Deductible Part-Time6
780.34
1,045.64
897.40
1,069.05
1 Available to PEBB eligible retirees. VSP routine vision services.
2 Available to PEBB eligible retirees in plan service area. VSP routine vision services.
3 Available to PEBB eligible retirees in plan service area. Kaiser 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.

2012 Retiree Optional Vision Plan Monthly Premium Rates
SelfSelf & Spouse/ Domestic PartnerSelf & ChildrenSelf & FamilyChild Only
VSP Optional Part-Time
$12.90
25.80
25.80
30.31
12.90


COBRA Rates
 
2012 COBRA Participant Medical Plan Monthly Premium Rates
 
Self
Self & Spouse/Partner
Self &     Children
Self & Family
Child(ren) Only7
PEBB Statewide PPO1
$996.88
$1,335.67
$1,146.33
$1,365.57
$510.71
Providence Choice2
875.66
1,173.34
1,007.01
1,199.63
453.61
Kaiser3
989.50
1,325.93
1,137.95
1,355.62
504.63
Kaiser Deductible3
909.79
1,219.10
1,046.26
1,246.41
463.97
PEBB Statewide Part-time PPO4
798.18
1,069.47
917.87
1,093.43
410.89
Providence Choice Part-time5
698.02
935.31
802.72
956.26
355.98
Kaiser Part-time6
837.67
1,122.47
963.32
1,147.59
427.20
Kaiser Deductible Part-Time6
791.15
1,060.14
909.83
1,083.87
403.48
1 Available to PEBB eligible individuals. VSP routine vision services.
2 Available to PEBB eligible individuals in plan service area. VSP routine vision services.
3 Available to PEBB eligible individuals in plan service area. Kaiser routine vision services.
4 Additional option available to PEBB eligible individuals. No vision benefit.
5 Additional option available to PEBB eligible individuals; in plan service area. No vision benefit.
6 Additional option available to PEBB eligible individuals; in plan service area. Vision exam only.
7 Child(ren) Only coverage is available only to COBRA & Retiree participants.