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2012 Medical Plan Premium Rates
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Article Content
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| Employee Rates |
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Employees
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Employee & Spouse/Partner
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Employee & Children
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Employee & Family
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PEBB Statewide PPO1
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$990.52
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$1,327.15
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$1,139.02
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$1,356.87
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Providence Choice2
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870.22
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1,166.06
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1,000.76
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1,192.18
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Kaiser3
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983.01
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1,317.23
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1,130.49
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1,346.73
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Kaiser Deductible3
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903.83
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1,211.11
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1,039.40
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1,238.24
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PEBB Statewide Part-time PPO4
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793.10
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1,062.66
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912.03
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1,086.46
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Providence Choice Part-time5
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693.57
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929.36
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797.61
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950.17
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Kaiser Part-time6
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832.18
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1,115.10
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957.00
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1,140.06
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Kaiser Deductible Part-Time6
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785.96
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1,053.18
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903.87
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1,076.76
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1 Available to PEBB eligible full-time and part-time employees. VSP routine vision services.
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2 Available to PEBB eligible full-time and part-time employees in plan service area. VSP routine vision services.
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3 Available to PEBB eligible full-time and part-time employees in plan service area. Kaiser routine vision services.
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4 Additional option available to eligible part-time employees. No vision benefit.
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5 Additional option available to eligible part-time employees in plan service area. No vision benefit.
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6 Additional option available to eligible part-time employees in plan service area. Vision exam only.
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| Retiree Rates |
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Retiree
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Retiree & Spouse/Partner
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Retiree & Children
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Retiree & Family
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PEBB Statewide PPO1
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$983.37
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$1,317.58
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$1,130.80
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$1,347.08
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Providence Choice2
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863.80
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1,157.46
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993.37
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1,183.38
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Kaiser3
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975.97
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1,307.80
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1,122.39
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1,337.09
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Kaiser Deductible3
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897.35
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1,202.44
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1,031.96
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1,229.37
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PEBB Statewide Part-Time PPO4
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787.38
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1,054.99
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905.45
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1,078.62
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Providence Choice Part-Time5
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688.57
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922.65
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791.85
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943.31
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Kaiser Part-Time6
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826.22
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1,107.12
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950.15
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1,131.90
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Kaiser Deductible Part-Time6
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780.34
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1,045.64
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897.40
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1,069.05
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1 Available to PEBB eligible retirees. VSP routine vision services.
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2 Available to PEBB eligible retirees in plan service area. VSP routine vision services.
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3 Available to PEBB eligible retirees in plan service area. Kaiser routine vision services.
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4 Additional option available to eligible retirees. No vision benefit.
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5 Additional option available to eligible retirees in plan service area. No vision benefit.
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6 Additional option available to eligible retirees in plan service area. Vision exam only.
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2012 Retiree Optional Vision Plan Monthly Premium Rates
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| Self | Self & Spouse/ Domestic Partner | Self & Children | Self & Family | Child Only |
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VSP Optional Part-Time
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$12.90
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25.80
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25.80
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30.31
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12.90
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| COBRA Rates |
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2012 COBRA Participant Medical Plan Monthly Premium Rates
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Self
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Self & Spouse/Partner
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Self & Children
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Self & Family
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Child(ren) Only7
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PEBB Statewide PPO1
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$996.88
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$1,335.67
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$1,146.33
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$1,365.57
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$510.71
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Providence Choice2
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875.66
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1,173.34
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1,007.01
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1,199.63
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453.61
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Kaiser3
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989.50
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1,325.93
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1,137.95
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1,355.62
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504.63
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Kaiser Deductible3
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909.79
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1,219.10
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1,046.26
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1,246.41
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463.97
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PEBB Statewide Part-time PPO4
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798.18
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1,069.47
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917.87
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1,093.43
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410.89
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Providence Choice Part-time5
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698.02
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935.31
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802.72
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956.26
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355.98
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Kaiser Part-time6
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837.67
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1,122.47
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963.32
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1,147.59
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427.20
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Kaiser Deductible Part-Time6
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791.15
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1,060.14
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909.83
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1,083.87
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403.48
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1 Available to PEBB eligible individuals. VSP routine vision services.
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2 Available to PEBB eligible individuals in plan service area. VSP routine vision services.
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3 Available to PEBB eligible individuals in plan service area. Kaiser routine vision services.
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4 Additional option available to PEBB eligible individuals. No vision benefit.
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5 Additional option available to PEBB eligible individuals; in plan service area. No vision benefit.
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6 Additional option available to PEBB eligible individuals; in plan service area. Vision exam only.
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7 Child(ren) Only coverage is available only to COBRA & Retiree participants.
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