Contribution Rates

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

Contributions for Active Employees

Medical/Vision Plan		With CIGNA Dental		With CareFirst Dental
Medical/Vision Plan		Full-Time	Part-Time	Full-Time	Part-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 Plan		With CIGNA Dental	With CareFirst Dental
Medical/Vision Plan		With CIGNA Dental	With 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
Medical/Vision Plan		Normal/Disability	Medicare	Survivors 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
Medical/Vision Plan		Normal/Disability	Medicare	Survivors 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)


Age 60-64 at Retirement		Age 55-59 at Retirement		Age 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)


Age 60-64 at Retirement		Age 55-59 at Retirement		Age 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