VSTRS Group Health Insurance Rates - All Rates are Monthly
VEHI Insurance Premiums Effective July 1, 2011
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 |
$629.82
|
$448.83
|
$180.99
|
1L
|
| Retiree and 1 Dependent |
$1,241.87
|
$448.83
|
$793.04
|
2L
|
| Retiree and Family |
$1,670.04
|
$448.83
|
$1,221.21
|
FL
|
| Retiree and 1 Dependent Medicare Eligible |
$1,141.09
|
$448.83
|
$692.26
|
TL
|
| Retiree and 2 Dependents, 1 of Whom is Medicare Eligible |
$1,753.14
|
$448.83
|
$1,304.31
|
3L
|
| Retiree Over 65 Medicare Eligible, Group Number: 80724-007 | ||||
| Retiree Only |
$511.27
|
$334.21
|
$177.06
|
1M
|
| Retiree and 1 Dependent Medicare Eligible |
$1.022.54
|
$334.21
|
$688.33
|
2M
|
| Retiree and 2 Dependents Medicare Eligible |
$1,533.81
|
$334.21
|
$1,199.60
|
FM
|
| Retiree and 1 Dependent Under 65 |
$1,141.09
|
$334.21
|
$806.88
|
TM
|
| Retiree and 2 Dependents Under 65 |
$1,753.14
|
$334.21
|
$1,418.93
|
3M
|
| Retiree WITHOUT MEDICARE, Group Number: 80724-001 | ||||
|
$591.68
|
$448.83
|
$142.85
|
XM
|
|
$250 Comprehensive Plan
| Total Premium | State Share | Retiree Share | Class Code | |
|---|---|---|---|---|
| Retiree Under 65, Group Number: 80724-200 | ||||
| Retiree Only |
$561.03
|
$483.83
|
$112.20
|
1L-C
|
| Retiree and 1 Dependent |
$1,102.81
|
$483.83
|
$653.98
|
2L-C
|
| Retiree and Family |
$1,478.37
|
$483.83
|
$1,029.54
|
FL-C
|
| Retiree and 1 Medicare Eligible Dependent |
$978.79
|
$483.83
|
$529.96
|
TL-C
|
| Retiree and 2 Dependents, 1 of Whom is Medicare Eligible |
$1520.57
|
$483.83
|
$1,071.74
|
3L-C
|
| Retiree Over 65 Medicare Eligible, Group Number: 80724-207 | ||||
| Retiree Only |
$417.76
|
$334.21
|
$83.55
|
1M-C
|
| Retiree and 1 Dependent Medicare Eligible |
$835.52
|
$334.21
|
$501.31
|
2M-C
|
| Retiree and 2 Dependents Medicare Eligible |
$1,253.28
|
$334.21
|
$919.07
|
FM-C
|
| Retiree and 1 Dependent Under 65 |
$978.79
|
$334.21
|
$644.58
|
TM-C
|
| Retiree and 2 Dependents Under 65 |
$1,520.57
|
$334.21
|
$1,186.36
|
3M-C
|
Vermont Health Partnership
| Total Premium | State Share | Retiree Share | Class Code | |
|---|---|---|---|---|
| Retiree Under 65, Group Number: 80724-100 | ||||
| Retiree Only |
$561.03
|
$448.83
|
$112.20
|
1L-V
|
| Retiree and 1 Dependent |
$1,102.81
|
$448.83
|
$653.98
|
2L-V
|
| Retiree and Family |
$1,478.37
|
$448.83
|
$1,029.54
|
FL-V
|
| Retiree-VT Health Partnership Dependent(s) - JY Carveout | ||||
| Retiree and 1 Dependent Medicare Eligible |
$1,072.30
|
$448.83
|
$623.47
|
TL-T
|
| Retiree and 2 Dependents, 1 of Whom is Medicare Eligible |
$1,614.08
|
$448.83
|
$1,165.25
|
3L-T
|
| Retiree-VT Health Partnership Dependent(s) - Comp Carveout | ||||
| Retiree and 1 Dependent Medicare Eligible |
$978.79
|
$448.83
|
$529.96
|
TL-U
|
| Retiree and 2 Dependents, 1 of Whom is Medicare Eligible |
$1,520.57
|
$448.83
|
$1,071.74
|
3L-U
|
| Retiree-VT Health Partnership Dependent(s) - Vermont Blue 65 | ||||
| Retiree and 1 Dependent Medicare Eligible |
$715.42
|
$448.83
|
$266.59
|
TL-W
|
| Retiree and 2 Dependents, 1 of Whom is Medicare Eligible |
$1,257.20
|
$448.83
|
$808.37
|
3L-W
|
Vermont Blue 65 Plan C
| Total Premium | State Share | Retiree Share | Class Code | |
|---|---|---|---|---|
| Retiree Over 65 Medicare Eligible, Group Number: 80724-300 | ||||
| Retiree Only |
$154.39
|
$154.39
|
$0.0
|
1M-X
|
| Retiree and 1 Dependent Medicare Eligible |
$308.78
|
$154.39
|
$154.39
|
2M-X
|
| Retiree and 2 Dependents Medicare Eligible |
$463.17
|
$154.39
|
$308.78
|
FM-X
|
| Retiree - Vermont Blue 65 Dependent(s) - JY Plan | ||||
| Retiree and 1 Dependent Under 65 |
$784.21
|
$154.39
|
$629.82
|
TM-Y
|
| Retiree and 2 Dependents Under 65 |
$1396.26
|
$154.39
|
$1,241.87
|
3M-Y
|
| Retiree - Vemont Blue 65 Dependent(s) - 250 Comprehensive Plan | ||||
| Retiree and 1 Dependent Under 65 |
$715.42
|
$154.39
|
$561.03
|
TM-#
|
| Retiree and 2 Dependents Under 65 |
$1,257.20
|
$154.39
|
$1,102.81
|
3M-#
|
| Retiree - Vermont Blue 65 Dependent(s) - VT Health Partnership | ||||
| Retiree and 1 Dependent Under 65 |
$715.42
|
$154.39
|
$561.03
|
TM-P
|
| Retiree and 2 Dependents Under 65 |
$1,257.20
|
$154.39
|
$1,102.81
|
3M-P
|
2010 VSTRS Group Health Insurance Rates
2009 VSTRS Group Health Insurance Rates
2008 VSTRS Group Health Insurance Rates
