Oklahoma State and Education Employees Group Insurance Board
Monthly Premiums for Former Employees and Surviving Dependents
Plan Year January 1, 2010 - December 31, 2010
| HEALTH PLANS | MEMBER | SPOUSE | CHILD | CHILDREN |
| HealthChoice High | $442.80 | $625.88 | $228.32 | $342.44 |
| HealthChoice Basic | $384.22 | $546.84 | $200.36 | $300.88 |
| HealthChoice S-Account | $365.80 | $513.68 | $190.32 | $283.98 |
| HealthChoice USA | $678.57 | $678.57 | $226.33 | $339.31 |
| Aetna Standard HMO | $715.40 | $951.38 | $488.78 | $782.04 |
| Aetna Alternative HMO | $502.32 | $668.02 | $343.20 | $549.12 |
| CommunityCare Standard HMO | $775.08 | $1108.34 | $387.54 | $620.06 |
| CommunityCare Alternative HMO | $534.54 | $764.38 | $267.28 | $427.64 |
| GlobalHealth Standard HMO | $344.18 | $510.70 | $184.56 | $294.30 |
| GlobalHealth Alternative HMO | $312.90 | $464.30 | $167.82 | $267.54 |
| PacifiCare Standard HMO | $605.20 | $870.16 | $302.38 | $483.92 |
| PacifiCare Alternative HMO | $417.38 | $600.10 | $208.52 | $333.72 |
| DENTAL PLANS | MEMBER | SPOUSE | CHILD | CHILDREN |
| HealthChoice Dental | $30.28 | $30.28 | $25.24 | $65.50 |
| Assurant Freedom Preferred | $26.33 | $26.18 | $19.63 | $52.79 |
| Assurant Heritage Plus with SBA (Prepaid) | $11.74 | $8.86 | $7.60 | $15.20 |
| Assurant Heritage Secure (Prepaid) | $7.20 | $5.98 | $5.20 | $10.38 |
| CIGNA Dental Care Plan (Prepaid) | $9.26 | $6.06 | $7.08 | $15.32 |
| Delta Dental PPO (POS) | $30.48 | $30.50 | $26.80 | $68.22 |
| Delta’s Choice (PPO) | $13.40 | $30.44 | $30.68 | $74.46 |
| VISION PLANS | MEMBER | SPOUSE | CHILD | CHILDREN |
| Humana/CompBenefits VisionCare Plan | $6.76 | $5.06 | $3.57 | $4.46 |
| Primary Vision Care Services | $9.25 | $8.00 | $8.50 | $10.75 |
| Superior Vision Services | $6.98 | $6.90 | $6.60 | $6.60 |
| UnitedHealthcare Vision | $8.18 | $5.79 | $4.59 | $6.98 |
| Vision Service Plan (VSP) | $8.96 | $6.00 | $5.74 | $12.92 |
| LIFE PLANS | PRE-MEDICARE RETIREE/VESTS | |||
| From $5,000 to $40,000 | $1.94 Per $1,000 | |||
| Age-Rated Supplemental Life Cost Per $1,000 for $41,000 and Up | ||||
| < 30 ---------- $0.05 | 45 - 49 ------- $ 0.19 | 65 - 69 ------- $0.99 | ||
| 30 - 34 ------- $0.05 | 50 - 54 ------- $ 0.32 | 70 - 74 ------- $1.67 | ||
| 35 - 39 ------- $0.08 | 55 - 59 ------- $0.52 | 75+ ----------- $2.60 | ||
| 40 - 44 ------- $0.12 | 60 - 64 ------- $0.60 | |||
| DEPENDENT LIFE | $0.97 Per $500 Unit, Per Dependent | |||
| SURVIVING DEPENDENTS OF CURRENT EMPLOYEES | LOW OPTION $2.60 |
STANDARD OPTION $4.32 |
PREMIER OPTION $8.64 |
|
| Spouse | $6,000 | $10,000 | $20,000 | |
| Child (age 6 months to 25) | $3,000 | $5,000 | $10,000 | |
| Child (live birth to 6 months) | $1,000 | $1,000 | $1,000 | |
| SURVIVING DEPENDENTS OF FORMER EMPLOYEES | $0.97 Per $500 Unit, Per Dependent | |||
| Rates do not reflect any retirement system contribution | ||||
Last Modified on 05/07/2010