2023 Retiree Benefit Plan Rates
Medical Plan Rates
| EPO | PPO | PCA High | PC Low | ULH | |
|---|---|---|---|---|---|
| Retiree Only | $445 | $416 | $353 | $291 | $385 |
| Retiree + Spouse/QA | $1,069 | $1,000 | $847 | $698 | $924 |
| Retiree + Child(ren) | $802 | $749 | $636 | $515 | $693 |
| Retiree + Family | $1,381 | $1,290 | $1,095 | $876 | $1,194 |
Dental Plan Rates
| Basic Dental Plan | Enhanced Dental Plan | |
|---|---|---|
| Retire Only | $22.42 | $36.52 |
| Retiree + Spouse/QA | $44.82 | $73.00 |
| Retiree + Children | $52.92 | $86.14 |
| Retiree + Family | $81.84 | $133.24 |
Vision Plan Rates
| Monthly Rate | |
|---|---|
| Retiree Only | $4.92 |
| Retiree + Spouse/QA | $8.92 |
| Retiree + Children | $9.46 |
| Retiree + Family | $13.58 |