|
RETIREE |
|||||
|
AGE |
PPO MEDICAL |
EPO MEDICAL |
PPO DENTAL |
HMO DENTAL |
TRANSAMERICA Group supplement to Medicare Plan with Prescription Drugs through Express Scripts |
|
Under Age 60 |
$913.35 |
$820.10 |
$43.21 |
$19.18 |
n/a |
|
Age 60-64 |
$0 |
$0 |
$0 |
$0 |
n/a |
|
Age 65 or Over |
n/a |
n/a |
$43.21 |
$19.18 |
$671.34 |
|
SPOUSE/DOMESTIC PARTNER |
|||||
|
Under Age 65 |
$1,094.96 |
$983.04 |
$46.68 |
$12.47 |
n/a |
|
Age 65 or Over |
n/a |
n/a |
$46.68 |
$12.47 |
$671.34 |
|
|
|||||
|
SINGLE DEPENDENT without Retiree |
|||||
|
Under 65 or under 26 if child |
$1,094.96 |
$983.04 |
$46.68 |
$12.47 |
n/a |
|
TWO OR MORE DEPENDENTS without Retiree |
|||||
|
Under 65 and under 26 if child |
$1,916.16 |
$1,720.32 |
$113.72 |
$31.37 |
n/a |
|
EMPLOYEE with Child(ren) under 26 |
|||||
|
Under 60 |
$1,643.30 |
$1,475.43 |
$98.51 |
$33.77 |
n/a |
|
EMPLOYEE & Family (spouse/DP under 65 & children under 26) |
|||||
|
Under 60 |
$2,829.51 |
$2,540.42 |
$156.93 |
$50.55 |
n/a |




