MERIT RETIREES
MONTHLY HEALTH AND DENTAL INSURANCE PREMIUMS
EFFECTIVE JANUARY 1, 2013
RETIREES UNDER 65
| SINGLE |
FAMILY |
|
Program 3 Plus |
$ 709.31 | $ 1,658.45 |
Iowa Select |
$ 707.05 | $ 1,653.18 |
Blue Access |
$ 440.96 | $ 1030.49 |
Blue Advantage |
$ 424.43 | $ 991.86 |
Gold Preferred PPO |
$ 559.36 | $ 1,307.57 |
RETIREES OVER 65
Plans not requiring purchase coordinating Part D Medicare Coverage
SINGLE |
FAMILY |
|
Program 3 Plus |
$ 782.86 | $ 1,670.05 |
Iowa Select |
$ 780.17 | $ 1,664.39 |
Blue Access |
$ 482.07 | $ 1,038.39 |
Blue Advantage |
$ 463.53 | $ 999.45 |
Gold Preferred PPO |
$ 579.96 | $ 1,315.23 |
Plans requiring purchase coordinating Part D Medicare Coverage*
SINGLE |
FAMILY |
|
Program 3 Plus |
$ 369.90 | $ 945.52 |
Iowa Select |
$ 368.75 | $ 942.66 |
Blue Access |
$ 230.75 | $ 597.64 |
Blue Advantage |
$ 222.12 | $ 576.06 |
Gold Preferred PPO |
$ 275.92 | $ 710.60 |
Program N ** |
$ 172.02 | NA *** |
*You must enroll in SilverScript for Part D prescription coverage
**Group Medicare Blue Rx
(Silver) 89.00
**Group Medicare Blue Rx (Gold) 145.00
***Family premium is NOT applicable for Program N. Spouse/partner and/or dependents can only be covered on Program N if they are also Medicare Eligible, and they would enroll in separate Single Program N and Medicare Blue Rx contracts.
Silver Script Part D Coverage $75.00
DENTAL
SINGLE |
FAMILY |
|
State Dental |
$ 29.13 | $ 78.29 |
UPDATED 11/12