Contribution Rates

Contributions/Basic Rates Through December 31, 2016 (See below for 2017 rates)

This charts below show the costs for the various coverage options effective January 1, 2016 — December 31, 2016.

Medical/Vision PlanWith CIGNA DentalWith CareFirst Dental
Full-TimePart-TimeFull-TimePart-Time
Kaiser Permanente Medical and NVA Vision Single   Family $97.63
$258.22
$220.56
$575.86
$98.99
$261.30
$223.13
$581.52
BlueChoice HMO Medical and Davis Vision* Single   Family $91.74
$241.02
$205.05
$529.69
$93.10
$244.10
$207.62
$535.35
CareFirst PPO Medical and Davis Vision* Single   Family $175.22
$437.17
$346.63
$855.71
$176.58
$440.25
$349.20
$861.37
Supplemental Orthodontic Single   Family n/a n/a $8.58
$27.44
$8.58
$27.44

* CareFirst PPO medical coverage is only available to employees hired before March 1, 2011. (Employees hired on or after March 1, 2011 are eligible to elect CareFirst PPO medical coverage after completing 39 months of service from the date of hire.)

Medical/Vision Plan
Normal/DisabilityMedicareSurvivors of RetireesSurvivors of Retirees on Medicare
Kaiser Permanente Medical and NVA Vision Single
Family
$90.81
$242.39
  $90.60
$242.18
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$48.91

$131.73


$101.32

 

$48.70

$131.52


$101.11

BlueChoice HMO Medical and Davis Vision* Single
Family
$85.32
$225.59
  $85.11
$225.38
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$56.69

$176.63


$139.11

 

$56.48

$176.42


$138.90

CareFirst PPO Medical and Davis Vision* Single
Family
$168.80
$421.81
  $168.59
$421.60
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$114.12

$330.44


$253.87

 

$113.91

$330.23


$253.66

Age Band$10K$35K$50K$70K$100K$150K$200K$250K$300K$400K
Less Than 25 $0.50 $1.75 $2.50 $3.75 $5.00 $7.50 $10.00 $12.50 $15.00 $20.00
25-29 $0.60 $2.10 $3.00 $4.50 $6.00 $9.00 $12.00 $15.00 $18.00 $24.00
30-34 $0.80 $2.80 $4.00 $6.00 $8.00 $12.00 $16.00 $20.00 $24.00 $32.00
35-39 $0.90 $3.15 $4.50 $6.75 $9.00 $13.50 $18.00 $22.50 $27.00 $36.00
40-44 $1.00 $3.50 $5.00 $7.50 $10.00 $15.00 $20.00 $25.00 $30.00 $40.00
45-49 $1.60 $5.60 $8.00 $12.00 $16.00 $24.00 $32.00 $40.00 $48.00 $64.00
50-54 $2.60 $9.10 $13.00 $19.50 $26.00 $39.00 $52.00 $65.00 $78.00 $104.00
55-59 $4.60 $16.10 $23.00 $34.50 $46.00 $69.00 $92.00 $115.00 $138.00 $184.00
60-64 $6.80 $23.80 $34.00 $51.00 $68.00 $102.00 $136.00 $170.00 $204.00 $272.00
65-69 $12.70 $44.45 $63.50 $95.25 $127.00 $190.50 $254.00 $317.00 $381.00 $508.00
70+ $20.60 $72.10 $103.00 $154.50 $206.00 $309.00 $412.00 $515.00 $618.00 $824.00
Medical/Vision PlanWith Cigna DentalWith CareFirst Dental
Kaiser Permanente Medical and NVA Vision Single
Family
$96.06
$256.65
$97.42
$259.73
BlueChoice HMO Medical and Davis Vision Single
Family
$90.17
$239.45
$91.53
$242.53
CareFirst PPO Medical and Davis Vision

Single
Family

$173.65
$435.60
$175.01
$438.68
Medical/Vision PlanAge 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
$135.27
$360.70

 

$179.69
$478.98
  $201.91
$538.13
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$74.72

$214.45


$160.43

 

$100.53

$297.16


$219.54

 

$113.43

$338.52


$249.10

BlueChoice HMO Medical and Davis Vision Single
Family
$125.95
$332.33
  $166.53
$439.03
  $186.83
$492.36
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$83.84

$262.64


$202.77

 

 $111.00

$348.66


$266.44

 

$124.57

$391.66


$298.27

CareFirst PPO Medical and Davis Vision Single
Family
$232.65
$580.49
  $296.48
$739.12
  $317.82
$797.60
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$158.10

$455.80


$350.42

 

$74.72

$214.45


$160.43

 

$74.72

$214.45


$160.43

 

 

Contributions/Basic Rates Through December 31, 2017

This charts below show the costs for the various coverage options effective January 1, 2017 — December 31, 2017.

Medical/Vision PlanWith CIGNA DentalWith CareFirst Dental
Full-TimePart-TimeFull-TimePart-Time
Kaiser Permanente Medical and NVA Vision Single   Family $106.54
$284.19
$236.14
$621.31
$108.04
$287.82
$238.95
$627.94
BlueChoice HMO Medical and Davis Vision* Single   Family $97.41
$256.55
$214.97
$556.86
$98.91
$260.18
$217.78
$563.49
CareFirst PPO Medical and Davis Vision* Single   Family $175.39
$439.09
$346.93
$859.05
$176.89
$442.72
$349.74
$865.68
Supplemental Orthodontic Single   Family n/a n/a $8.72
$27.15
$8.72
$27.15

* CareFirst PPO medical coverage is only available to employees hired before March 1, 2011. (Employees hired on or after March 1, 2011 are eligible to elect CareFirst PPO medical coverage after completing 39 months of service from the date of hire.)

Medical/Vision Plan
Normal/DisabilityMedicareSurvivors of RetireesSurvivors of Retirees on Medicare
Kaiser Permanente Medical and NVA Vision Single
Family
$102.63
$271.27
  $100.63
$269.27
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$53.53

$148.10


$109.29

 

$51.53

$146.10


$107.29

BlueChoice HMO Medical and Davis Vision* Single
Family
$93.91
$244.02
  $91.91
$242.02
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$59.37

$181.73


$136.97

 

$57.37

$179.73


$134.97

CareFirst PPO Medical and Davis Vision* Single
Family
$171.88
$426.64
  $169.88
$424.64
 
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$107.83

$305.36


$234.41

 

$105.83

$303.36


$232.41

Age Band$10K$35K$50K$70K$100K$150K$200K$250K$300K$400K
Less Than 25 $0.50 $1.75 $2.50 $3.75 $5.00 $7.50 $10.00 $12.50 $15.00 $20.00
25-29 $0.60 $2.10 $3.00 $4.50 $6.00 $9.00 $12.00 $15.00 $18.00 $24.00
30-34 $0.80 $2.80 $4.00 $6.00 $8.00 $12.00 $16.00 $20.00 $24.00 $32.00
35-39 $0.90 $3.15 $4.50 $6.75 $9.00 $13.50 $18.00 $22.50 $27.00 $36.00
40-44 $1.00 $3.50 $5.00 $7.50 $10.00 $15.00 $20.00 $25.00 $30.00 $40.00
45-49 $1.60 $5.60 $8.00 $12.00 $16.00 $24.00 $32.00 $40.00 $48.00 $64.00
50-54 $2.60 $9.10 $13.00 $19.50 $26.00 $39.00 $52.00 $65.00 $78.00 $104.00
55-59 $4.60 $16.10 $23.00 $34.50 $46.00 $69.00 $92.00 $115.00 $138.00 $184.00
60-64 $6.80 $23.80 $34.00 $51.00 $68.00 $102.00 $136.00 $170.00 $204.00 $272.00
65-69 $12.70 $44.45 $63.50 $95.25 $127.00 $190.50 $254.00 $317.00 $381.00 $508.00
70+ $20.60 $72.10 $103.00 $154.50 $206.00 $309.00 $412.00 $515.00 $618.00 $824.00
Medical/Vision PlanWith Cigna DentalWith CareFirst Dental
Kaiser Permanente Medical and NVA Vision Single
Family
$106.09
$283.74
$107.59
$287.37
BlueChoice HMO Medical and Davis Vision Single
Family
$96.96
$256.10
$98.46
$259.73
CareFirst PPO Medical and Davis Vision

Single
Family

$174.94
$438.64
$176.44
$438.64
Medical/Vision PlanAge 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
$150.61
$398.22

 

$198.58
$525.17
  $222.57
$588.64
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$80.73

$235.73


$170.79

 

$107.92

$323.36


$232.30

 

$121.52

$367.17


$263.05

BlueChoice HMO Medical and Davis Vision Single
Family
$137.07
$356.24
  $180.23
$468.47
  $201.81
$524.58
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$87.33

$269.27


$199.99

 

 $115.28

$356.80


$263.01

 

$129.26

$400.57


$294.53

CareFirst PPO Medical and Davis Vision Single
Family
$236.63
$586.72
  $301.39
$746.79
  $333.76
$826.83
 

Single Medicare
Family 1 Medicare
Family 2 Medicare

 

$149.92

$423.19


$325.12

 

$192.01

$541.02


$415.82

 

$213.06

$599.94


$461.18

 

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FAQs

My spouse and I are legally separated. Can I remove my spouse from my coverage?

Your spouse’s coverage ends if you get divorced or if your marriage is annulled. If you are separated but still legally married, your spouse is still covered. You can remover him or her during the annual open enrollment.  Your domestic partner loses coverage when your relationship no longer meets the criteria for a domestic partner relationship.

If you and your spouse are divorced, you should notify the Health & Welfare Plan Office immediately. If you fail to remove your divorced spouse from the Plan, you could be liable for any expenses claimed by your former spouse after the date of the divorce. For more information, see the Life Events page.

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