Insurance Rates - 2015

VEHI Insurance Premiums Effective July 1, 2015

Withholding starts with the June 30 pension payment.

   JY Plan

 

  Total Premium State Share Retiree Share Class Code
Retiree Under 65, Group Number: 80724-000
Retiree Only
$783.04
$558.02
$225.02
1L
Retiree and 1 Dependent
$1,543.98
$558.02
$985.96
2L
Retiree and Family
$2,076.31
$558.02
$1,518.29
FL
Retiree and 1 Dependent Medicare Eligible
$1,418.68
$558.02
$860.66
TL
Retiree and 2 Dependents, 1 of Whom is Medicare Eligible
$2,076.31
$558.02
$1,518.29
3L
Retiree Over 65 Medicare Eligible, Group Number: 80724-007 or 80724-237
Retiree Only                 $635.64           $415.51            $220.13 1M
Retiree and 1 Dependent Medicare Eligible
$1,271.28
$415.51
$855.77
2M
Retiree and 1 Dependent Medicare Eligible - Dep no RX coverage
$1,006.71
$415.51
$591.20
2DM
Retiree and 2 Dependents Medicare Eligible
$1906.92
$415.51
$1,491.41
FM
Retiree and 1 Dependent Under 65
$1,418.68
$415.51
$1,003.17
TM
Retiree and 2 Dependents Under 65
$2,076.31
$415.51
$1,660.80
3M
Retiree WITHOUT RX COVERAGE, Group Number: 80724-247
 
$371.07
$203.85
$167.22
DM

 

   $300 Comprehensive Plan

 

  Total Premium State Share Retiree Share Class Code
Retiree Under 65, Group Number: 80724-200
Retiree Only    
$697.52
$558.02
$139.50
1L-C
Retiree and 1 Dependent
$1,371.09
$558.02
$813.07
2L-C
Retiree and Family
$1,838.01
$558.02
$1,279.99
FL-C
Retiree and 1 Medicare Eligible Dependent
$1,216.91
$558.02
$658.89
TL-C
Retiree and 2 Dependents, 1 of Whom is Medicare Eligible
$1,838.01
$558.02
$1,279.99
3L-C
Retiree under 65 & 1 Medicare Eligible Dependent WITHOUT RX COVERAGE $952.33 $558.02 $394.31 DL-C
Retiree Over 65 or Medicare Eligible, Group Number: 80724-207 or 80724-337
Retiree Only              
$519.39
$415.51
$103.88
1M-C
Retiree and 1 Dependent Medicare Eligible
$1,038.78
$415.51
$623.27
2M-C
Retiree and 2 Dependents Medicare Eligible
$1,558.17
$415.51
$1,142.66
FM-C
Retiree and 1 Dependent Under 65
$1,216.91
$415.51
$801.40
TM-C
Retiree Medicare Eligible w/o Rx & 1 Dependent Under 65 $952.33 $203.85 $748.48 DTM-C
Retiree and 2 Dependents Under 65
$1,838.01
$415.51
$1,422.50
3M-C
Retiree and 1 Dependent Over and 1 Dependent Under 65
$1,736.30
$415.51
$1,320.79
4M-C
Retiree and 2 Dependents Under 65 and 1 Dependent Over
$1,838.01
$415.51
$1,422.50
5M-C
Retiree Over 65 and Family Under
$1,838.01
$415.51
$1,422.50
FLM-C
Group Number: 80724-347 WITHOUT RX COVERAGE
$254.81
$203.85
$50.96
DM-C
 

 

   Vermont Health Partnership

 

  Total Premium State Share Retiree Share Class Code
Retiree Under 65, Group Number: 80724-100
Retiree Only
$697.52
$558.02
$139.50
1L-V
Retiree and 1 Dependent
$1,371.09
$558.02
$813.07
2L-V
Retiree and Family
$1,838.01
$558.02
$1,279.99
FL-V
Retiree-VT Health Partnership Dependent(s) - JY Carveout
Retiree and 1 Dependent Medicare Eligible
$1,333.16
$558.02
$775.14
TL-T
Retiree and 2 Dependents, 1 of Whom is Medicare Eligible
$2,006.73
$558.02
$1,448.71
3L-T
Retiree-VT Health Partnership Dependent(s) - Comp Carveout
Retiree and 1 Dependent Medicare Eligible
$1,216.91
$558.02
$658.89
TL-U
Retiree and 2 Dependents, 1 of Whom is Medicare Eligible
$1,890.48
$558.02
$1,332.46
3L-U
Retiree-VT Health Partnership Dependent(s) - Vermont Blue 65
Retiree and 1 Dependent Medicare Eligible
$889.47
$558.02
$331.45
TL-W
Retiree and 2 Dependents, 1 of Whom is Medicare Eligible
$1,563.04
$558.02
$1,005.02
3L-W
 

 

   Vermont Blue 65

 

  Total Premium State Share Retiree Share Class Code
Retiree Over 65 Medicare Eligible, Group Number: 80724-300
Retiree Only
$191.95
$191.95
$0.00
1M-X
Retiree and 1 Dependent Medicare Eligible
$383.90
$191.95
$191.95
2M-X
Retiree and 2 Dependents Medicare Eligible
$575.85
$191.95
$383.90
FM-X
Retiree - Vermont Blue 65             Dependent(s) - JY Plan
Retiree and 1 Dependent Under 65
$974.99
$191.95
$783.04
TM-Y
Retiree and 2 Dependents Under 65
$1,735.93
$191.95
$1,543.98
3M-Y
Retiree - Vemont Blue 65             Dependent(s) Comp
Retiree and 1 Dependent Under 65
$889.47
$191.95
$697.52
TM-#
Retiree and 2 Dependents Under 65
$1,563.04
$191.95
$1,371.09
3M-#
Retiree - Vermont Blue 65           Dependent(s) - VT Health Partnership
Retiree and 1 Dependent Under 65
$889.47
$191.95
$697.52
TM-P
Retiree and 2 Dependents Under 65
$1,563.04
$191.95
$1,371.09
3M-P
 

 

2015 VSTRS Group Health Insurance Rates

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