Health Care Coverage (until Medicare eligible) |
| |
Total Monthly Rate |
|
UD
Pays |
|
Retiree
Pays |
| Blue Cross Blue Shield (BCBSDE) - First State Basic |
|
|
|
|
|
| Retiree |
$514.56 |
|
$514.56 |
|
$0.00 |
| Retiree & Spouse |
$1,064.66 |
|
$1,064.66 |
|
$0.00 |
| Retiree & Child(ren) |
$782.20 |
|
$782.20 |
|
$0.00 |
| Family |
$1,330.86 |
|
$1,330.86 |
|
$0.00 |
| BCBSDE - Comprehensive PPO |
|
|
|
|
|
| Retiree |
$587.46 |
|
$514.56 |
|
$72.90 |
| Retiree & Spouse |
$1,219.04 |
|
$1,064.66 |
|
$154.38 |
| Retiree & Child(ren) |
$905.38 |
|
$782.20 |
|
$123.18 |
| Family |
$1,523.98 |
|
$1,330.86 |
|
$193.12 |
| BCBSDE - BlueCARE® HMO |
|
|
|
|
|
| Retiree |
$537.66 |
|
$514.56 |
|
$23.10 |
| Retiree & Spouse |
$1,136.22 |
|
$1,064.66 |
|
$71.56 |
| Retiree & Child(ren) |
$822.62 |
|
$782.20 |
|
$40.42 |
| Family |
$1,417.62 |
|
$1,330.86 |
|
$86.76 |
| Aetna - HMO |
|
|
|
|
|
| Retiree |
$537.22 |
|
$514.56 |
|
$22.66 |
| Retiree & Spouse |
$1,132.64 |
|
$1,064.66 |
|
$67.98 |
| Retiree & Child(ren) |
$821.80 |
|
$782.20 |
|
$39.60 |
| Family |
$1,413.30 |
|
$1,330.86 |
|
$82.44 |
| BCBSDE - CDH Gold |
|
|
|
|
|
| Retiree |
$532.56 |
|
$514.56 |
|
$18.00 |
| Retiree & Spouse |
$1,104.26 |
|
$1,064.66 |
|
$39.60 |
| Retiree & Child(ren) |
$813.70 |
|
$782.20 |
|
$31.50 |
| Family |
$1,402.86 |
|
$1,330.86 |
|
$72.00 |
| Aetna - CDH Gold |
|
|
|
|
|
| Retiree |
$532.56 |
|
$514.56 |
|
$18.00 |
| Retiree & Spouse |
$1,104.26 |
|
$1,064.66 |
|
$39.60 |
| Retiree & Child(ren) |
$813.70 |
|
$782.20 |
|
$31.50 |
| Family |
$1,402.86 |
|
$1,330.86 |
|
$72.00 |
| |
Individual Medicare Supplements (Retiree and/or Spouse, when Medicare eligible) |
| |
Total Monthly Rate |
|
UD
Pays |
|
Retiree
Pays |
| Special Medicfill With Prescription Coverage |
$414.26 |
|
$414.26 |
|
$0 |
| Special Medicfill WITHOUT Prescription Coverage |
$191.76 |
|
$191.76 |
|
$0 |
| (Medicare Supplement plans WITHOUT prescription coverage are provided for Medicare participants enrolled in Medicare Part D.) |
|
|
|
|
|
|
|
|
|
|
|
|
| |
 Benefits Highlights for Medicare Beneficiaries |
| |
Dental Coverage |
| |
Total Monthly Rate |
|
UD
Pays |
|
Retiree
Pays |
| Met Life - Dental COBRA (max 18 months) |
|
|
|
|
|
| Retiree |
$40.94 |
|
$0 |
|
$40.94 |
| Retiree & Spouse |
$82.42 |
|
$0 |
|
$82.42 |
| Retiree & Child(ren) |
$92.21 |
|
$0 |
|
$92.21 |
| Family |
$134.03 |
|
$0 |
|
$134.03 |
| Dominion - Dental HMO |
|
|
|
|
|
| Retiree |
$22.68 |
|
$0 |
|
$22.68 |
| Retiree & Spouse |
$42.14 |
|
$0 |
|
$42.14 |
| Retiree & Child(ren) |
$45.42 |
|
$0 |
|
$45.42 |
| Family |
$61.66 |
|
$0 |
|
$61.66 |
| Delta Dental - PPO Plus Premier |
|
|
|
|
|
| Retiree |
$31.62 |
|
$0 |
|
$31.62 |
| Retiree & Spouse |
$64.54 |
|
$0 |
|
$64.54 |
| Retiree & Child(ren) |
$63.34 |
|
$0 |
|
$63.34 |
| Family |
$105.70 |
|
$0 |
|
$105.70 |
|
|
|
|
|
|
|
|
|
|
|
|
| |
Vision Coverage |
| |
Total Monthly Rate |
|
UD
Pays |
|
Retiree
Pays |
| Superior Vision Plan (U.D. Retirees) |
|
|
|
|
|
| Retiree |
$6.24 |
|
$0 |
|
$6.24 |
| Retiree & Spouse |
$13.40 |
|
$0 |
|
$13.40 |
| Retiree & Child(ren) |
$10.10 |
|
$0 |
|
$10.10 |
| Family |
$18.38 |
|
$0 |
|
$18.38 |
