Available Plans and Monthly Premiums Effective July 1, 2007 For Active Employees and Participants Not Eligible for Medicare Important information about your premiums is listed below. |
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| Health Plans | Single (You Only) |
Plus One (You and One Family Member) |
Family (You and Two or More Family Members) |
| Available Statewide | |||
| COVA HDHP (High Deductible Health Plan) Employee Pays Employer Pays Total Premium |
$ 0 $350 $350 |
$ 0 $648 $648 |
$0 $947 $947 |
| COVA Care (includes basic dental) Employee Pays Employer Pays Total Premium |
$ 42 $395 $437 |
$103 $706 $809 |
$147 $1035 $1182 |
| COVA Care Plus Out-of-Network Employee Pays Employer Pays Total Premium |
$ 52 $395 $447 |
$117 $706 $823 |
$166 $1035 $1201 |
| COVA Care Plus Expanded Dental Employee Pays Employer Pays Total Premium |
$ 55 $395 $450 |
$128 $706 $834 |
$185 $1035 $1220 |
| COVA Care Plus Vision, Hearing and Expanded Dental Employee Pays Employer Pays Total Premium |
$ 64 $395 $459 |
$145 $706 $851 |
$207 $1035 $1242 |
| COVA Care Plus Out-of-Network and Expanded Dental Employee Pays Employer Pays Total Premium |
$ 65 $395 $460 |
$142 $706 $848 |
$203 $1035 $1238 |
| COVA Care Plus Out-of-Network, Vision, Hearing and Expanded Dental Employee Pays Employer Pays Total Premium |
$ 74 $395 $469 |
$158 $706 $864 |
$224 $1035 $1259 |
| Available in Northern VA Only | |||
| Kaiser Permanente Employee Pays Employer Pays Total Premium |
$ 42 $392 $434 |
$102 $701 $803 |
$146 $1026 $1172 |
| Employee, Employee on Military Leave, VSDP Short-Term Disability: Pays the Employee amount | |||
| Retiree Group Not Eligible for Medicare (Retirees, Survivors, VSDP Long-Term Disability): Pays the Total Premium (VRS- administered health insurance credit may apply) | |||
| Part-time Classified Employee: Pays the Total Premium | |||
PRINTER VERSION