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Download PDF Rate Sheet (252.2 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 | $676.81 | N/A | $540.57 | N/A | $1,085.52 | $666.90 | N/A |
| Group Health Value |
N/A | $627.91 | N/A | $503.90 | N/A | $999.95 | $630.23 | 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) |
$131.86 | N/A | N/A | $258.19 | N/A | $258.19 | N/A | N/A | N/A | $384.52 |
| Group Health Medicare Plan (Original Medicare) |
$131.86 | N/A | N/A | $258.19 | N/A | $258.19 | N/A | N/A | N/A | $384.52 |
| Kaiser Permanente Senior Advantage Classic |
$149.23 | $681.88 | N/A | $292.93 | $548.72 | $292.93 | $1,081.37 | N/A | $692.42 | $436.63 |
| Premera Blue Cross Plan F Age 65 or older, eligible by age | $99.77 | $625.35 | $270.17 | $194.01 | $493.96 | N/A | $1,019.54 | $664.36 | $588.20 | N/A |
| Premera Blue Cross Plan F Under age 65, eligible by disability | $175.93 | $701.51 | $270.17 | $346.33 | $570.12 | N/A | $1,095.70 | $664.36 | $740.52 | N/A |
| Uniform Medical Plan Classic (Medicare) |
$213.87 | $739.45 | N/A | $422.21 | $608.06 | $422.21 | $1,133.64 | N/A | $816.40 | $630.55 |
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 |
* 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.
