Plan Year 2011 Rate Tables

Plan Year 2010 Rate Tables

• Active employee premium cost includes coverage for medical, dental, vision, life, accidental death & dismemberment, business travel accident and long-term disability insurance.

• Retiree premium cost includes medical, dental, vision, life and accidental death & dismemberment insurance.

Scroll through the tables until you find your status, e.g., state/non-state active employee, state/non-state retiree, etc., from one of the following groups:

State active employee:

Select the medical plan option, deductible level and the applicable dependent coverage tier (employee only or employee + spouse + children + family). State active employee premium cost may be found in the shaded column represented by active employee contribution.

State retiree:

Select the medical plan option, deductible level and the applicable dependent coverage tier (employee only or employee + spouse + children + family) and Medicare status. State retiree premium cost may be found in the shaded column represented by retiree contribution. Refer to the State Retiree Premium Adjustment Table to determine the qualifying subsidy amount; add or subtract the amount of subsidy to/from the premium found on the rate table.

Non-state active employee:

Select the medical plan option, deductible level and the applicable dependent coverage tier (employee only or employee + spouse + children + family). Non-state active employee premium cost may be found in the shaded column represented by active employee contribution.

Non-state retiree:

Select the medical plan option, deductible level and the applicable dependent coverage tier (employee only or employee + spouse + children + family) and Medicare status. Non-state retiree premium cost may be found on the Non-state Rate Table. Refer to the Non-State Retiree Subsidy Table; add or subtract the qualifying subsidy amount from the premium found on the Non-state Rate Table.

Survivors and COBRA participants:

Locate the monthly premium cost by referring to the appropriate premium table and selecting the applicable medical plan option, Medicare status and dependent coverage tier. Survivor and COBRA participants do not receive life, accidental death and dismemberment, business travel or long-term disability insurance benefits.