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

My girlfriend just had a baby. Can I add the child to our plan?

Yes, as long as the newborn child is your natural child, your legally adopted child, or you are the child’s legal guardian. If your girlfriend is covered under the Plan as your domestic partner, your child may also be added to the Plan. You’ll need to show documents of proof to the Health & Welfare Plan Office. For more information on dependent eligibility, see Eligibility for Your Spouse and Children.

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