| 2009 Medical Premium Rates |
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| Employee Rates |
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View as a PDF
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2009 Employee Medical Plan Monthly Premium Rates
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Employees
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Employee & Spouse/Partner
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Employee & Children
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Employee & Family
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Kaiser Permanente HMO1
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$756.46 |
$1,013.67
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$869.94
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$1,036.36
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Kaiser Permanente Added Choice POS2
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800.25
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1,072.34
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920.29
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1,096.34
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ProvidenceChoice PPO3
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750.79
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1,006.02
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863.41
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1,028.56
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Regence BCBSO PPO3
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834.18
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1,117.67
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959.24
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1,142.69
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Kaiser Permanente Part-time & Retiree HMO4
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640.38
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858.11
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736.43
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877.32
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Kaiser Permanente Added Choice Part-time & Retiree POS4
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647.45
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867.58
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744.57
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887.01
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ProvidenceChoice Part-time & Retiree PPO5
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593.49
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795.27
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682.52
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813.08
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Regence BCBSO Part-time & Retiree PPO5
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662.68
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887.91
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762.05
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907.81
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1 Kaiser Permanente HMO routine vision services
2 Routine vision services only through Kaiser Permanente HMO
3 Routine vision services through VSP
4 Vision exam only
5 No vision benefit
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| Part-time Employee Calculation Worksheet |
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2009 Part-time Employees Prorated Monthly Benefit Amount Calculation
For Those Enrolling in a Full-time Medical Plan
1.a Prorated monthly benefit amount based on hours worked compared with full-time
Select the coverage tier that applies to you. Multiply the Full-time Monthly Benefit Amount for the coverage tier you selected by the percentage of hours you work compared with full time. The result is an estimate of your Prorated Monthly Benefit Amount.
Coverage Tier
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Full-time Monthly Benefit Amount
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% Hours Worked
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Prorated Monthly Benefit Amount
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Employee only
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$896.28
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X _______%
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= $____________
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Employee & spouse/domestic partner
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$1,206.86
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X _______%
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= $____________
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Employee & children
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$1,032.11
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X _______%
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= $____________
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Employee & family
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$1,232.75
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X _______%
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= $____________
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1.b Subside amount if your enroll in a Part-time and Retiree Medical Plan
Next to your coverage tier, enter your Prorated Monthly Benefit Amount from the calculation above. Add the Subsidy for Part-time Plans for your coverage tier. The result is an estimate of your subsidized benefit amount if you enroll in a part-time plan.
Coverage Tier
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Prorated Monthly Benefit Amount
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Subsidy for Part-time Plan
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Subsidized Monthly Benefit Amount
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Employee only
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$_______________
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+ $206.94
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= $_____________
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Employee & spouse/domestic partner
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$_______________
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+ $264.11
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= $_____________
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Employee & children
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$_______________
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+ $235.47
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= $_____________
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Employee & family
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$_______________
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+ $268.05
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= $_____________
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1.
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Enter the monthly benefit amount you calculated in 1.a or 1.b above.
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$______________
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2.
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Enter $1.10 for mandatory basic life insurance.
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$______________
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3.
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Enter your monthly medical premium cost.
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$______________
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4.
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Enter your monthly dental premium cost. (You must have at least employee-only dental coverage. You may also cover dependents.)
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$______________
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5.
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Enter the sum of 2 through 4. This is your monthly premium cost..
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$______________
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6.
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Subtract line 5 from line 1. This is the estimated monthly payroll deduction for your medical, dental and basic life coverage.
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$______________
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| Part-time Employee Calculation Examples |
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2009 Example Calculations for Part-time Employees Enrolling in Part-time & Retiree
Calculations show estimated premium costs for part-time employees working a given percentage of hours compared with full time. In no case will the monthly benefit amount plus subsidy exceed the cost of premiums for core benefits.
Examples with choice of ODS Dental
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2009 Part-time & Retiree Kaiser Permanente HMO with Part-time & Retiree ODS Dental
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50% Contribution (works 50% of full time)
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80% Contribution (works 80% of full time)
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Subsidized Contribution
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655.08
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867.54
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751.53
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884.43
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694.80
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930.67
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798.86
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951.48
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Medical Rate
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640.38
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858.11
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736.43
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877.32
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640.38
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858.11
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736.43
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877.32
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Dental Rate
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53.32
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71.46
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61.33
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73.06
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53.32
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71.46
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61.33
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73.06
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Basic Life
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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Total Rate
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694.80
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930.67
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798.86
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951.48
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694.80
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930.67
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798.86
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951.48
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Employee Balance
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-39.72
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-63.13
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-47.33
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-67.05
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0.00*
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0. 00*
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0.00*
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0.00*
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2009 Part-time & Retiree Providence Choice PPO with Part-time & Retiree ODS Dental
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50% Contribution (works 50% of full time)
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80% Contribution (works 80% of full time)
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Subsidized Contribution
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647.91
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867.54
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744.95
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884.43
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647.91
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867.83
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744.95
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887.24
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Medical Rate
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593.49
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795.27
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682.52
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813.08
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593.49
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795.27
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682.52
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813.08
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Dental Rate
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53.32
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71.46
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61.33
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73.06
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53.32
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71.46
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61.33
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73.06
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Basic Life
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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Total Rate
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647.91
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867.83
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744.95
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887.24
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647.91
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867.83
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744.95
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887.24
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Employee Balance
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0.00
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-0.29
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0.00
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-2.81
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0.00*
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0.00*
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0.0*0
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0.0*0
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2009 Part-time & Retiree Regence BCBSO PPO with Part-time & Retiree ODS Dental
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50% Contribution (works 50% of full time)
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80% Contribution (works 80% of full time)
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Subsidized Contribution
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655.08
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867.54
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751.53
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884.43
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717.10
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960.47
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824.48
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981.97
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Medical Rate
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662.68
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887.91
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762.05
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907.81
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662.68
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887.91
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762.05
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907.81
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Dental Rate
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53.32
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71.46
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61.33
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73.06
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53.32
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71.46
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61.33
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73.06
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Basic Life
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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Total Rate
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717.10
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960.47
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824.48
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981.97
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717.10
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960.47
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824.48
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981.97
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Employee Balance
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-62.02
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-92.93
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-72.95
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-97.54
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0.00*
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0.00*
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0.0*0
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0.00*
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Examples with choice of Kaiser Permanente Dental
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2009 Part-time & Retiree Kaiser Permanente HMO with Part-time & Retiree Kaiser Dental
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50% Contribution (works 50% of full time)
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80% Contribution (works 80% of full time)
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Subsidized Contribution
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655.08
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867.54
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751.53
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884.43
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693.57
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929.01
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797.43
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949.79
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Medical Rate
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640.38
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858.11
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736.43
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877.32
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640.38
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858.11
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736.43
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877.32
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Dental Rate
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52.09
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69.80
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59.90
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71.37
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52.09
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69.80
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59.90
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71.37
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Basic Life
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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Total Rate
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693.57
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929.01
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797.43
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949.79
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693.57
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929.01
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797.43
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949.79
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Employee Balance
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-38.49
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-61.47
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-45.90
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-65.36
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0.00*
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0.00*
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0.00*
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0.0*0
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2009 Part-time & Retiree Providence Choice PPO with Part-time & Retiree Kaiser Dental
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50% Contribution (works 50% of full time)
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80% Contribution (works 80% of full time)
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Subsidized Contribution
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646.68
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866.17
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743.52
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884.43
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646.68
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866.17
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743.52
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885.55
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Medical Rate
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593.49
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795.27
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682.52
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813.08
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593.49
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795.27
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682.52
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813.08
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Dental Rate
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52.09
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69.80
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59.90
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71.37
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52.09
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69.80
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59.90
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71.37
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Basic Life
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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Total Rate
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646.68
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866.17
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743.52
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885.55
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646.68
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866.17
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743.52
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885.55
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Employee Balance
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0.00
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0.00
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0.00
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-1.12
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0.00*
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0.00*
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0.00*
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0.0*0
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2009 Part-time & Retiree Regence BCBSO PPO with Part-time & Retiree Kaiser Dental
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50% Contribution (works 50% of full time)
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80% Contribution (works 80% of full time)
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Employee
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Employee, Spouse/Partner
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Employee, Child(ren)
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Employee, Family
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Subsidized Contribution
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655.08
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867.54
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751.53
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884.43
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715.87
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958.81
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823.05
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980.28
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Medical Rate
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662.68
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887.91
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762.05
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907.81
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662.68
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887.91
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762.05
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907.81
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Dental Rate
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52.09
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69.80
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59.90
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71.37
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52.09
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69.80
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59.90
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71.37
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Basic Life
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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1.10
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Total Rate
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715.87
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958.81
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823.05
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980.28
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715.87
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958.81
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823.05
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980.28
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Employee Balance
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-60.79
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-91.27
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-71.52
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-95.85
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0.00*
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0.0*0
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0.00*
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0.0*0
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*
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| Calculations for Medical Coverage Opt Out |
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Calculation Worksheet for Employees Who Choose
to Opt Out of PEBB Medical Coverage
- Full-time Employees:Enter $233.00
- Part-time Employees: Multiply $233.00 by the percentage of hours you work compared with full time. For example, if you work 75 percent of full time, your contribution amount is $174.75 ($233.00 x 0.75= $174.75). Enter the result.
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1.___________
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- Enter $1.10. This is the monthly premium for mandatory basic life insurance.
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2.___________
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- Enter the monthly premium amount for your choice of dental plan from page. You are required to be enrolled in at least the employee-only tier for dental coverage. You may also choose to cover eligible dependents.
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3.___________
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- Add lines 2 and 3, and enter the total.
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4.___________
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- Subtract the amount on line 4 from the amount on line 1, and enter the balance on line 5. This is the estimated amount of opt-out cash you will receive as monthly taxable income.
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5.___________
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| Retirees |
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View rates as a PDF
2009 Retiree Medical Plan Monthly Premium Rates
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Retiree
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Retiree & Spouse/Partner
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Retiree & Children
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Retiree & Family
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Kaiser Permanente HMO1
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$759.47
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$1,017.70
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$873.40
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$1,040.48
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Kaiser Permanente Added Choice POS2
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803.43
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1,076.60
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923.95
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1,100.70
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ProvidenceChoice PPO3
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753.77
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1,010.03
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866.84
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1,032.65
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Regence BCBSO PPO3
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837.49
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1,122.11
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963.05
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1,147.24
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Kaiser Permanente Part-time & Retiree HMO4
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642.93
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861.52
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739.36
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880.81
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Kaiser Permanente Added Choice Part-time & Retiree POS4
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650.03
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871.03
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747.53
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890.54
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ProvidenceChoice Part-time & Retiree PPO5
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595.85
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798.44
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685.23
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816.31
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Regence BCBSO Part-time & Retiree PPO5
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665.32
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891.44
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765.08
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911.42
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1 Kaiser Permanente HMO routine vision services
2 Routine vision services only through Kaiser Permanente HMO
3 Routine vision services through VSP
4 Vision exam only
5 No vision benefit
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| COBRA Participants |
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View rates as a PDF
2009 COBRA Participant Medical Plan Monthly Premium Rates
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Self
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Self & Spouse/Partner
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Self & Children
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Self & Family
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Kaiser Permanente HMO1
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$770.75
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$1,032.81
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$886.37
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$1,055.93
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Kaiser Permanente Added Choice POS2
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815.37
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1,092.59
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937.67
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1,117.05
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ProvidenceChoice PPO3
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764.97
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1,025.02
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879.72
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1,047.99
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Regence BCBSO PPO3
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849.93
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1,138.77
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977.36
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1,164.28
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Kaiser Permanente Part-time & Retiree HMO4
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652.47
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874.31
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750.34
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893.89
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Kaiser Permanente Added Choice Part-time & Retiree POS4
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659.68
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883.97
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758.63
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903.76
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ProvidenceChoice Part-time & Retiree PPO5
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604.70
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810.29
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695.41
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828.44
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Regence BCBSO Part-time & Retiree PPO5
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675.20
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904.68
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776.44
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924.96
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1 Kaiser Permanente HMO routine vision services
2 Routine vision services only through Kaiser Permanente HMO
3 Routine vision services through VSP
4 Vision exam only
5 No vision benefit
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| Other Self-pay Participants |
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These medical premium rates are for the following self-pay groups: Blind Business Enterprise employees, OLCC agents, state-certified foster parents, J1 Visa holders and OUS post docs.
View rates as a PDF
2009 Self-pay Participant Medical Plan Monthly Premium Rates
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Self
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Self & Spouse/Partner
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Self & Children
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Self & Family
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Kaiser Permanente HMO¹
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$766.76
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$1,023.97
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$880.24
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$1,046.66
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Kaiser Permanente Added Choice POS2
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810.55
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1,082.64
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930.59
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1,106.64
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ProvidenceChoice PPO³
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761.09
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1,016.32
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873.71
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1,038.86
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Regence BCBSO PPO³
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844.48
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1,127.97
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969.54
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1,152.99
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1 Kaiser Permanente HMO routine vision services
2 Routine vision services only through Kaiser Permanente HMO
3 Routine vision services through VSP
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