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Download PDF Rate Sheet (268.1 KB)Medical
| Plan | Subscriber Only | Subscriber & Spouse* | Subscriber & Children | Full Family | ||||
|---|---|---|---|---|---|---|---|---|
| Persons Medicare Eligible | 1 | 1 | 2 | 1 | 2 | 1 | 2 | 3 |
| Group Health Classic |
N/A | $803.14 | N/A | $666.90 | N/A | $1,211.85 | $919.56 | N/A |
| Group Health Value |
N/A | $754.24 | N/A | $630.23 | N/A | $1,126.28 | $882.89 | N/A |
Additional Medicare Options
| Plan | Subscriber Only | Subscriber & Spouse* | Subscriber & Children | Full Family | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Persons Medicare Eligible | 1 | 1 | 2 (1/1) | 2 | 1 | 2 | 1 | 2 (1/1) | 2 | 3 |
| Group Health Medicare Plan (Medicare Advantage) |
$258.19 | N/A | N/A | $510.85 | N/A | $510.85 | N/A | N/A | N/A | $763.51 |
| Group Health Medicare Plan (Original Medicare) |
$258.19 | N/A | N/A | $510.85 | N/A | $510.85 | N/A | N/A | N/A | $763.51 |
| Kaiser Permanente Senior Advantage Classic |
$292.94 | $825.59 | N/A | $580.35 | $692.43 | $580.35 | $1,225.08 | N/A | $979.84 | $867.76 |
| Premera Blue Cross Plan F Age 65 or older, eligible by age | $188.48 | $719.59 | $508.88 | $376.96 | $588.20 | N/A | $1,113.78 | $908.60 | $776.68 | N/A |
| Premera Blue Cross Plan F Under age 65, eligible by disability | $320.40 | $851.51 | $508.88 | $640.80 | $720.12 | N/A | $1,245.70 | $908.60 | $1,040.52 | N/A |
| Uniform Medical Plan Classic (Medicare) |
$363.87 | $889.45 | N/A | $722.21 | $758.06 | $722.21 | $1,283.64 | N/A | $1,116.40 | $1,080.55 |
Dental (with Medical)
| Plan | Subscriber Only | Subscriber & Spouse* | Subscriber & Children | Full Family |
|---|---|---|---|---|
| DeltaCare | $39.53 | $79.06 | $79.06 | $118.59 |
| Uniform Dental Plan | $45.20 | $90.40 | $90.40 | $135.60 |
| Willamette Dental | $42.68 | $85.36 | $85.36 | $128.04 |
Dental (without Medical)
| Plan | Subscriber Only | Subscriber & Spouse* | Subscriber & Children | Full Family |
|---|---|---|---|---|
| DeltaCare | $45.06 | $84.59 | $84.59 | $124.12 |
| Uniform Dental Plan | $50.73 | $95.93 | $95.93 | $141.13 |
| Willamette Dental | $48.21 | $90.89 | $90.89 | $133.57 |
* Or Qualified/Washington State Registered Domestic Partner
Uniform Medical Plan has an out of state network for care in other states.
If a Medicare supplement plan is selected, non-Medicare eligible dependents are enrolled in the Uniform Medical Plan (UMP). The rates shown reflect the total due, including premiums for both plans.
Managed-care dental plans require you to receive care from an approved office location. Please visit the Dental Benefits page for additional information and office locations.
