Contribution Rates

Contributions/Basic Rates for the various coverage options effective January 1, 2021 through December 31, 2021

 

Contributions for Active Employees

Medical/Vision PlanWith CIGNA DentalWith CareFirst Dental
Full-TimePart-TimeFull-TimePart-Time
Kaiser Permanente Medical and NVA Vision Single Family $127.54
$342.36
$255.45
$685.92
$128.35
$343.48
$257.05
$688.16
BlueChoice HMO Medical and Davis Vision* Single Family $118.88
$313.09
$237.95
$626.86
$119.69
$314.21
$239.55
$629.10
CareFirst POS Medical and Davis Vision* Single Family $159.10
$410.46
$323.15
$830.42
$115.90
$411.58
$324.74
$832.66
Supplemental Orthodontic Single Family

n/a

n/a $3.72
$14.76
$3.72
$14.76

 

Contributions for Survivors of Active Employees

Medical/Vision PlanWith CIGNA DentalWith CareFirst Dental
Kaiser Permanente Medical and NVA Vision Single Family $116.06
$311.14
$116.87
$312.26
BlueChoice HMO Medical and Davis Vision* Single Family $110.26
$290.10
$111.07
$291.22
CareFirst POS Medical and Davis Vision* Single Family $169.79
$437.89
$170.59
$439.01
Supplemental Orthodontic Single Family

n/a
n/a

$3.72
$14.76

 

Normal Retired Employees and Survivors of Retirees - 2021 Rates

 

Contributions for NORMAL Retired Employees and Survivors of Retired Employees (who retired BEFORE January 1, 2019)

Medical/Vision Plan
Normal/DisabilityMedicareSurvivors of Retirees
Kaiser Permanente Medical and NVA Vision Single
Family
$111.86
$296.82
  $110.02
$294.88
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$50.88

$173.63


$107.18

 
BlueChoice HMO Medical and Davis Vision* Single
Family
$106.46
$276.08
  $104.52
$274.14
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$67.82

$215.22


$145.47

 
CareFirst BC Advantage Medical (POS) and Davis Vision* Single
Family
$165.99
$423.94
  $164.05
$422.00
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$114.38

$343.84


$248.73

 

 

Contributions for NORMAL Retired Employees and Survivors of Retired Employees (who retired ON OR AFTER January 1, 2019)

Medical/Vision Plan
Normal/DisabilityMedicareSurvivors of Retirees
Kaiser Permanente Medical and NVA Vision Single
Family
$123.62
$328.27
  $121.68
$326.33
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$62.66

$224.98


$142.86

 
BlueChoice HMO Medical and Davis Vision* Single
Family
$114.82
$298.58
  $112.88
$296.64
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$74.23

$237.90


$159.91

 
CareFirst BC Advantage Medical (POS) and Davis Vision* Single
Family
$158.85
$403.00
  $159.91
$401.06
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$110.67

$327.20


$239.43

 

 

Early Retired Employees and Survivors of Retirees - 2021 Rates

 

Contributions for EARLY Retired Employees and Survivors of Retired Employees (who retired BEFORE January 1, 2019)

Medical/Vision Plan
Age 60-64 at RetirementAge 55-59 at RetirementAge 50-54 at Retirement
    Pre-Medicare Medicare Pre-Medicare Medicare Pre-Medicare Medicare
Kaiser Permanente Medical and NVA Vision Single
Family
$163.59
$432.28
  $215.21
$567.74
  $241.02
$635.47
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$78.13

$269.76

 

$168.90

 

$105.38

$365.90

 

$230.62

 

$119.01

$413.97

 

$261.48

BlueChoice HMO Medical and Davis Vision* Single
Family
$154.23
$398.77
  $202.01
$521.46
  $225.89
$582.80
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$99.16

$313.65

 

$211.88

 

$130.50

$412.09

 

$278.30

 

$146.17

$461.31

 

$311.51

CareFirst BC Advantage Medical (POS) and Davis Vision* Single
Family
$229.82
$584.06
  $293.65
$744.18
  $325.57
$824.23
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$159.29

$474.07

 

$344.58

 

$204.19

$604.30

 

$440.43

 

$226.64

$669.41

 

$488.36

 

Contributions for EARLY Retired Employees and Survivors of Retired Employees (who retired ON OR AFTER January 1, 2019)

Medical/Vision Plan
Age 60-64 at RetirementAge 55-59 at RetirementAge 50-54 at Retirement
    Pre-Medicare Medicare Pre-Medicare Medicare Pre-Medicare Medicare
Kaiser Permanente Medical and NVA Vision Single
Family
$174.08
$460.58
  $224.53
$592.90
  $249.76
$659.05
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$88.73

$315.98

 

$201.01

 

$114.80

$406.98

 

$259.16

 

$127.83

$452.48

 

$288.24

BlueChoice HMO Medical and Davis Vision* Single
Family
$161.76
$419.02
  $208.70
$539.46
  $232.17
$599.68
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$104.93

$334.06

 

$224.88

 

$135.62

$430.23

 

$289.85

 

$150.97

$478.31

 

$322.34

CareFirst BC Advantage Medical (POS) and Davis Vision* Single
Family
$223.39
$565.22
  $287.94
$727.43
  $320.21
$808.53
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$155.94

$459.10

 

$336.22

 

$201.22

$590.99

 

$433.00

 

$223.86

$656.93

 

$481.39

 

MetLife Term Life Insurance Rates - 2021

Age Band$10K$35K$50K$75K$100K$150K$200K$250K$300K$400K$500K
Less Than 25 $0.45 $1.58 $2.25 $3.38 $4.50 $6.75 $9.00 $11.25 $13.50 $18.00 $22.50
25-29 $0.54 $1.89 $2.70 $4.05 $5.40 $8.10 $10.80 $13.50 $16.20 $21.60 $27.00
30-34 $0.72 $2.52 $3.60 $5.40 $7.20 $10.80 $14.40 $18.00 $21.60 $28.80 $36.00
35-39 $0.81 $2.84 $4.05 $6.08 $8.10 $12.15 $16.20 $20.25 $24.30 $32.40 $40.50
40-44 $0.90 $3.15 $4.50 $6.75 $9.00 $13.50 $18.00 $22.50 $27.00 $36.00 $45.00
45-49 $1.44 $5.04 $7.20 $10.80 $14.40 $21.60 $28.80 $36.00 $43.20 $57.60 $72.00
50-54 $2.30 $8.05 $11.50 $17.25 $23.00 $34.50 $46.00 $57.50 $69.00 $92.00 $115.00
55-59 $3.74 $13.09 $18.70 $28.05 $37.40 $56.10 $74.80 $93.50 $112.20 $149.60 $187.00
60-64 $5.56 $19.46 $27.80 $41.70 $55.60 $83.40 $111.20 $139.00 $166.80 $222.40 $278.00
FAQs Icon

FAQs

Can I add my Mom/Dad to my health plan?

No, you can only add your spouse or eligible dependent children to the Plan. For more information, see the Eligibility section.

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