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Employee Benefits - Health

State Retiree Health Benefits Program
Medicare- Eligible Plans

Monthly Premiums - Effective January 1 - December 31, 2012
One Person
Two Persons **

Advantage 65



Advantage 65 + Dental/Vision



Advantage 65 - Medical Only*



Advantage 65 - Medical Only+ Dental/Vision*




*These plans do not include prescription drug coverage


Option I - Medicare Complementary



Option II - Medicare Supplemental



Option II + Dental/Vision




** Two persons may choose the same plan or different Medicare-eligible plans; the total premium is the sum of each selection.

Important: Timely payment of the total premium is the State retiree group member's responsibility whether the premium is withheld from a retirement benefit or billed directly by the health plan. Failure to pay premiums within 31 days of the due date will result in termination of coverage.