Page 7 - B12797-ITDR-Enrollment-Guide-2020
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2020 Monthly Plan Premium Rates At-A-Glance
Medical Plans for Medicare Eligible Retirees
1 Person Rate
$610.61
$1,221.22
$313.13
$626.26
$252.62
$505.24
$67.91
$135.82
$330.79
$661.58
$226.99
$453.98
Plan Option
Aetna Traditional Choice with Rx 1505 Aetna Medicare PPO – Premier Plan Aetna Medicare PPO – Medium Plan Aetna Medicare PPO – Value Plan Aetna Medicare HMO Plan
Kaiser Permanente Senior Advantage HMO Plan (includes medical, dental and vision)
Plan Option
Aetna Choice PPO – High Option
Aetna Choice PPO – Medium Option Aetna Choice PPO – Low Option
Aetna HMO
Kaiser HMO (includes medical and vision)
Plan Option
Aetna Dental PPO Plan
Plan Option
Aetna Vision Preferred Plan
2 Person Rate*
Medical Plans for Non-Medicare Eligible Retirees
1 Person Rate
$1,622.94
$3,245.87
$1,148.89
$2,297.79
$733.51
$1,467.02
$1,084.56
$2,169.13
$764.10
$1,528.18
2 Person Rate*
Dental Plans for Medicare and Non-Medicare Eligible Retirees
1 Person Rate
$42.14
$84.28
2 Person Rate*
2 Person Rate*
Vision Plans for Medicare and Non-Medicare Eligible Retirees
1 Person Rate
$7.32
$14.46
*2 person rate assumes Retiree & Spouse. For Retiree & child rates for the medical plan, please contact the Retiree Service Center. Dental and Vision Retiree & Child rates are listed beginning on page 12.
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