CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011
Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.
Retirees' State Health Plan Blue Cross Blue Shield PPO
121BCBS G RetireeOnly L Retiree& Spouse R Retiree& Child(ren) W Retiree,Spouse & Child(ren) H Retiree65+ Only M Retiree65+ & Spouse 65+ S Retiree65+ & Child(ren) X Retiree65+ & Spouse 65+ & Child(ren) N Retireeunder 65 & Spouse 65+ P Retiree65+ & Spouse under 65 Y Retireeunder 65, Spouse 65+ & Child(ren) Z Retiree65+, Spouse under 65 & Child(ren)
Sponsored Dependent under 65 Sponsored Dependent 65+
DDR E RetireeOnly S Retiree& Spouse C Retiree& Child(ren) F Retiree,Spouse & Child(ren)
VBR E RetireeOnly S Retiree& Spouse C Retiree& Child(ren) F Retiree,Spouse & Child(ren)
CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011
Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.
Blue Care Network MidMichigan
Retiree StateMONTHLY 171 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $491.64 $697.66 $1,189.30 L Retiree& Spouse$ 983.28$ 1,395.31$ 2,378.59 R Retiree& Child(ren)$ 619.71$ 878.80$ 1,498.51 W Retiree,Spouse & Child(ren)$ 1,143.93$ 1,615.24$ 2,759.17 Rates for Retirees or Dependents with Medicare. Service Area:Clinton, Eaton, Ingham, and Jackson Counties. H Retiree65+ Only$ 47.93$ 385.05$ 432.98 M Retiree65+ & Spouse 65+$ 95.84$ 770.12$ 865.96 S Retiree65+ & Child(ren)$ 166.45$ 575.74$ 742.19 X Retiree65+ & Spouse 65+ & Child(ren)$ 173.52$ 1,001.65$ 1,175.17 N Retireeunder 65 & Spouse 65+$ 502.85$ 1,119.43$ 1,622.28 P Retiree65+ & Spouse under 65$ 502.85$ 1,119.43$ 1,622.28 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 580.54$ 1,350.95$ 1,931.49 Z Retiree65+, Spouse under 65 & Child(ren)$ 580.54$ 1,350.95$ 1,931.49
Blue Care Network East MichiganFlint
Retiree StateMONTHLY 181 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $390.02 $697.66 $1,087.68 L Retiree& Spouse$ 780.05$ 1,395.31$ 2,175.36 R Retiree& Child(ren)$ 491.68$ 878.80$ 1,370.48 W Retiree,Spouse & Child(ren$ 908.18$ 1,615.24$ 2,523.42 Rates for Retirees or Dependents with Medicare. Service Area:Bay, Genesee, Gratiot, Lapeer, Midland, Shiawassee, and Tuscola Counties. H Retiree65+ Only$ 65.46$ 385.05$ 450.51 M Retiree65+ & Spouse 65+$ 130.90$ 770.12$ 901.02 S Retiree65+ & Child(ren)$ 157.57$ 575.74$ 733.31 X Retiree65+ & Spouse 65+ & Child(ren)$ 182.17$ 1,001.65$ 1,183.82 N Retireeunder 65 & Spouse 65+$ 418.76$ 1,119.43$ 1,538.19 P Retiree65+ & Spouse under 65$ 418.76$ 1,119.43$ 1,538.19 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 470.04$ 1,350.95$ 1,820.99 Z Retiree65+, Spouse under 65 & Child(ren)$ 470.04$ 1,350.95$ 1,820.99
CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011
Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.
Blue Care Network East MichiganSaginaw
Retiree StateMONTHLY 191 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $298.42 $697.66 $996.08 L Retiree& Spouse$ 596.85$ 1,395.31$ 1,992.16 R Retiree& Child(ren)$ 376.26$ 878.80$ 1,255.06 W Retiree,Spouse & Child(ren$ 695.67$ 1,615.24$ 2,310.91 Rates for Retirees or Dependents with Medicare. Service Area:Saginaw County. H Retiree65+ Only$ 65.46$ 385.05$ 450.51 M Retiree65+ & Spouse 65+$ 130.90$ 770.12$ 901.02 S Retiree65+ & Child(ren)$ 133.75$ 575.74$ 709.49 X Retiree65+ & Spouse 65+ & Child(ren)$ 158.35$ 1,001.65$ 1,160.00 N Retireeunder 65 & Spouse 65+$ 327.16$ 1,119.43$ 1,446.59 P Retiree65+ & Spouse under 65$ 327.16$ 1,119.43$ 1,446.59 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 354.62$ 1,350.95$ 1,705.57 Z Retiree65+, Spouse under 65 & Child(ren)$ 354.62$ 1,350.95$ 1,705.57
Retiree StateMONTHLY Retiree 211 ShareShare TOTALCOBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $468.14 $697.66 $1,165.80 $1,189.12 L Retiree& Spouse$ 936.28$ 1,395.31$ 2,331.59$ 2,378.22 R Retiree& Child(ren)$ 590.10$ 878.80$ 1,468.90$ 1,498.28 W Retiree,Spouse & Child(ren$ 1,089.41$ 1,615.24$ 2,704.65$ 2,758.74 Rates for Retirees or Dependents with Medicare. Service Area:Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw, and Wayne Counties. H Retiree65+ Only$ 101.30$ 385.05$ 486.35$ 496.08 M Retiree65+ & Spouse 65+$ 195.70$ 770.12$ 972.70$ 992.15 S Retiree65+ & Child(ren)$ 187.90$ 575.74$ 789.45$ 805.24 X Retiree65+ & Spouse 65+ & Child(ren)$ 244.90$ 1,001.65$ 1,275.80$ 1,301.32 N Retireeunder 65 & Spouse 65+$ 443.25$ 1,119.43$ 1,652.15$ 1,685.19 P Retiree65+ & Spouse under 65$ 443.25$ 1,119.43$ 1,652.15$ 1,685.19 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 492.46$ 1,350.95$ 1,955.25$ 1,994.36 Z Retiree65+, Spouse under 65 & Child(ren)$ 492.46$ 1,350.95$ 1,955.25$ 1,994.36
CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011
Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.
Blue Care Network West MichiganGreat Lakes
Retiree StateMONTHLY Retiree 311 ShareShare TOTALCOBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $359.92 $697.66 $1,057.58 $1,078.73 L Retiree& Spouse$ 719.84$ 1,395.31$ 2,115.15$ 2,157.45 R Retiree& Child(ren)$ 453.75$ 878.80$ 1,332.55$ 1,359.20 W Retiree,Spouse & Child(ren$ 838.33$ 1,615.24$ 2,453.57$ 2,502.64 Rates for Retirees or Dependents with Medicare. Service Area:Allegan, Barry, Calhoun, Ionia, Kalamazoo, Kent, Montcalm, Muskegon, Newaygo, and Ottawa Counties. H Retiree65+ Only$ 22.03$ 385.05$ 407.08$ 415.22 M Retiree65+ & Spouse 65+$ 44.04$ 770.12$ 814.16$ 830.44 S Retiree65+ & Child(ren)$ 106.31$ 575.74$ 682.05$ 695.69 X Retiree65+ & Spouse 65+ & Child(ren)$ 87.48$ 1,001.65$ 1,089.13$ 1,110.91 N Retireeunder 65 & Spouse 65+$ 345.23$ 1,119.43$ 1,464.66$ 1,493.95 P Retiree65+ & Spouse under 65$ 345.23$ 1,119.43$ 1,464.66$ 1,493.95 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 388.68$ 1,350.95$ 1,739.63$ 1,774.42 Z Retiree65+, Spouse under 65 & Child(ren)$ 388.68$ 1,350.95$ 1,739.63$ 1,774.42
Health Alliance Plan
Retiree StateMONTHLY 201 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $240.87 $697.66 $938.53 L Retiree& Spouse$ 481.75$ 1,395.31$ 1,877.06 R Retiree& Child(ren)$ 303.77$ 878.80$ 1,182.57 W Retiree,Spouse & Child(ren$ 562.15$ 1,615.24$ 2,177.39 Rates for Retirees or Dependents with Medicare. Service Area:Genesee, Lapeer, Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw, and Wayne Counties. H Retiree65+ Only$ 5.25$ 385.05$ 390.30 M Retiree65+ & Spouse 65+$ 10.48$ 770.12$ 780.60 S Retiree65+ & Child(ren)$ 58.60$ 575.74$ 634.34 X Retiree65+ & Spouse 65+ & Child(ren)$ 79.28$ 1,001.65$ 1,080.93 N Retireeunder 65 & Spouse 65+$ 209.40$ 1,119.43$ 1,328.83 P Retiree65+ & Spouse under 65$ 209.40$ 1,119.43$ 1,328.83 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 278.21$ 1,350.95$ 1,629.16 Z Retiree65+, Spouse under 65 & Child(ren)$ 278.21$ 1,350.95$ 1,629.16
CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011
Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.
HealthPlus Retiree StateMONTHLY 622 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $387.46 $697.66 $1,085.12 L Retiree& Spouse$ 774.93$ 1,395.31$ 2,170.24 R Retiree& Child(ren)$ 488.45$ 878.80$ 1,367.25 W Retiree,Spouse & Child(ren$ 902.24$ 1,615.24$ 2,517.48 Rates for Retirees or Dependents with Medicare. Service Area:Arenac, Bay, Genesee, Lapeer, Oakland, Saginaw, Shiawassee, St. Clair and Tuscola Counties. H Retiree65+ Only$ 25.60$ 385.05$ 410.65 M Retiree65+ & Spouse 65+$ 51.18$ 770.12$ 821.30 S Retiree65+ & Child(ren)$ 328.80$ 575.74$ 904.54 X Retiree65+ & Spouse 65+ & Child(ren)$ 313.54$ 1,001.65$ 1,315.19 N Retireeunder 65 & Spouse 65+$ 376.35$ 1,119.43$ 1,495.78 P Retiree65+ & Spouse under 65$ 376.35$ 1,119.43$ 1,495.78 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 354.98$ 1,350.95$ 1,705.93 Z Retiree65+, Spouse under 65 & Child(ren)$ 354.98$ 1,350.95$ 1,705.93
Retiree StateMONTHLY Retiree 878 ShareShare TOTALCOBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility.This HMO is not available to retirees who are Medicare eligible or to retirees with Medicareeligible dependents. G RetireeOnly $294.24 $697.66 $991.90 $1,011.73 L Retiree& Spouse$ 588.47$ 1,395.31$ 1,983.78$ 2,023.46 R Retiree& Child(ren)$ 370.60$ 878.80$ 1,249.40$ 1,274.39 W Retiree,Spouse & Child(ren$ 681.29$ 1,615.24$ 2,296.53$ 2,342.46
CIVIL SERVICE COMMISSION EMPLOYEE BENEFIT DIVISION FY 20112012 GROUP INSURANCE PREMIUM RATES STATE POLICE RETIREMENT MONTHLYRATES EFFECTIVE OCTOBER 1, 2011
Rates apply to retirees under the State's Defined Benefit Retirement Plan and to those who converted from the Defined Benefit Plan to the Defined Contribution plan.
Priority West
Retiree StateMONTHLY 555 ShareShare TOTAL Rates for Retirees without Medicare.See enclosed postal code list for eligibility. G RetireeOnly $339.78 $697.66 $1,037.44 L Retiree& Spouse$ 677.45$ 1,395.31$ 2,072.76 R Retiree& Child(ren)$ 427.01$ 878.80$ 1,305.81 W Retiree,Spouse & Child(ren$ 789.14$ 1,615.24$ 2,404.38 Rates for Retirees or Dependents with Medicare. Service Area:Allegan, Antrim, Benzie, Crawford, Grand Traverse, Kalkaska, Kent, Leenanau, Manistee, Montcalm, Muskegon, Oceana, Osceola, and Ottawa Counties. H Retiree65+ Only$ 242.32$ 385.05$ 627.37 M Retiree65+ & Spouse 65+$ 484.62$ 770.12$ 1,254.74 S Retiree65+ & Child(ren)$ 537.42$ 575.74$ 1,113.16 X Retiree65+ & Spouse 65+ & Child(ren)$ 738.88$ 1,001.65$ 1,740.53 N Retireeunder 65 & Spouse 65+$ 257.53$ 1,119.43$ 1,376.96 P Retiree65+ & Spouse under 65$ 257.53$ 1,119.43$ 1,376.96 Y Retireeunder 65, Spouse 65+ & Child(ren)$ 511.80$ 1,350.95$ 1,862.75 Z Retiree65+, Spouse under 65 & Child(ren)$ 511.80$ 1,350.95$ 1,862.75
Retiree StateMONTHLY Retiree Share ShareTOTAL COBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility.This HMO is not available to retirees who are Medicare eligible or to retirees with Medicareeligible dependents. G RetireeOnly $339.78 $697.66 $1,037.44 $1,058.19 L Retiree& Spouse$ 677.45$ 1,395.31$ 2,072.76$ 2,114.22 R Retiree& Child(ren)$ 427.01$ 878.80$ 1,305.81$ 1,331.93 W Retiree,Spouse & Child(ren$ 789.14$ 1,615.24$ 2,404.38$ 2,452.47
Priority South
Retiree StateMONTHLY Retiree Share ShareTOTAL COBRA Rates for Retirees without Medicare.See enclosed postal code list for eligibility.This HMO is not available to retirees who are Medicare eligible or to retirees with Medicareeligible dependents. G RetireeOnly $339.78 $697.66 $1,037.44 $1,058.19 L Retiree& Spouse$ 677.45$ 1,395.31$ 2,072.76$ 2,114.22 R Retiree& Child(ren)$ 427.01$ 878.80$ 1,305.81$ 1,331.93 W Retiree,Spouse & Child(ren$ 789.14$ 1,615.24$ 2,404.38$ 2,452.47