Healthcare Rate Sheet
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Age Range 65 - 66 67 - 69 70 - 74 75 - 79 80+ Plan A Plan F Plan N 179.50 196.62 224.26 247.06 271.47 249.25 271.95 310.27 341.12 373.52 179.37 195.69 223.28 245.53 269.19 UnitedHealthcare Pharmacy Plans (Medicare Part D only) Medicare RX Saver Plus Plan Medicare RX Preferred Comprehensive Plan Premier Plan 27.50 63.80 100.01 249.35 2016 Rate Sheet Provider Benefit Standard DHMO Tier Monthly Rate Retiree only 7.91 Retiree Family 20.14 Retiree only 13.31 Retiree Family 33.98 Retiree only 17.24 Retiree Family 52.90 Retiree only 40.63 Retiree Family 121.48 Retiree only 8.33 Retiree Family 21.20 Retiree only 10.86 Retiree Family 27.70 Retiree only 18.15 Retiree Family 55.68 Retiree only 37.92 Retiree Family 113.36 Retiree only 5.06 Retiree Family 12.21 Retiree only 5.30 Retiree Family 13.26 Retiree only 7.95 Retiree Family 13.95 Legal Plan Retiree Family 14.76 SeniorAdvocate Plan Retiree Family 7.76 Legal Plan Retiree Family 15.95 Senior Plan Retiree Family 6.35 Hospital Indemnity Coverage 50/Day Retiree only 2.48 Cigna Hospital Hospital Indemnity Coverage Indemnity Coverage 100/Day Plans Hospital Indemnity Coverage 150/Day Retiree Family 6.20 Retiree only 4.96 Retiree Family 12.40 Retiree only 7.44 Retiree Family 18.60 High DHMO Delta Dental Plans Indemnity PPO Standard Indemnity PPO High Solstice Access Standard DHMO UnitedHealthcare Dental Plans Solstice Access High DHMO Indemnity PPO Standard Indemnity PPO High Davis Vision Plan Vision UnitedHealthcare Vision Plan Vision ID Watchdog Identity Theft Protection Plan Identify Theft Protection ARAG Legal Plans MetLaw Legal Plans 2016 Rate Sheet Provider Benefit Tier Age Reduction Amount Monthly 10,000 3.00 20,000 6.00 30,000 9.00 40,000 12.00 MetLife Life Retiree Only Under 65 100 of original policy 50,000 15.00 60,000 18.00 70,000 21.00 80,000 24.00 90,000 27.00 100,000 30.00 6,500 1.95 13,000 3.90 19,500 5.85 26,000 7.80 MetLife Life Reti
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