Retirees before 11/01/2012 |
Monthly | ||
|
Retiree Contributions |
EE Contribution | ||
|
Under Age 65 |
HMO – Triple S PPO |
Employee Only |
100.53 191.00 261.18 |
| Under Age 65 | Retiree Value Plan RPO |
Employee Only Employee Plus 1 Employee Plus 2 |
155.00 310.00 465.00 |
| Under Age 65 | Retiree Standard Plan (Non-Prefunded only) |
Employee Only Employee Plus 1 Employee Plus 2 |
115.00 230.00 345.00 |
| Age 65 and Over | Standard Plan (Non-Prefunded only) |
Employee Only Employee Plus 1 |
55.00 110.00 |
Retirees after or on 11/01/2012 |
Monthly | |||
| Retiree Contributions | Plan | Employee Only | Employee Plus 1 | Employee Plus 2 |
| Under Age 65 | HMO-Triple S (Puerto Rico Only) |
$482.35 | $916.65 | $1,252.85 |
| Under Age 65 | Retiree Value Plan | $1,576.00 | $3,152.00 | $4,728.00 |
| Under Age 65 | Standard Plan | $1,042.00 | $2,084.00 | $3,126.00 |
Printable Version: HERE