Monthly GIC Plan Rates as of July 1, 2015

Download a State Retiree Rate Sheet pdf format of 2015ratesheet.pdf

NON-MEDICARE PLANS

NON-MEDICARE RETIREES Retired on or before

July 1, 1994 And SURVIVORS1,2

NON-MEDICARE RETIREES Retired

after July 1, 1994 and who filed for retirement on or before October 1, 2009

NON-MEDICARE RETIREES who 

 filed for retirement after October 1, 2009

10%15%20%
Retiree/Survivor Pays MonthlyRetiree Pays Monthly

Retiree Pays

 Monthly

Basic Life Insurance Only

($5,000 coverage)

$0.63$0.95$1.26

HEALTH PLAN

(Premium includes Basic Life Insurance)

PLAN TYPE

Individual CoverageFamily CoverageIndividual CoverageFamily CoverageIndividual CoverageFamily Coverage

Fallon Health

Direct Care ($)

HMO

$49.72$118.46$74.59$177.69$99.45$236.91

Fallon Health

Select Care

HMO

65.87157.2098.81235.80131.73314.39

Harvard Pilgrim Independence

Plan

POS

75.27182.75112.91274.13150.54365.50
Harvard Pilgrim Primary Choice ($)

HMO

60.34146.3390.52219.50120.68292.65
Health New England ($)

HMO

49.85122.6674.78183.9999.70245.31
NHP Prime (Neighborhood Health Plan) ($)

HMO

47.51124.8771.27187.3195.03249.74
Tufts Health Plan Navigator

POS

66.29160.9599.44241.43132.58321.90
Tufts Health Plan Spirit ($)

EPO (HMO-TYPE)

50.57120.9375.86181.41101.14241.87

UniCare State Indemnity

Plan/Basic with CIC3

(Comprehensive)

Indemnity

135.65315.90182.40424.96229.14534.01

UniCare State Indemnity

Plan/Basic without CIC

(Non-Comprehensive)te Indemnity Plan/Community Choice ($)

PPO-type

47.67113.8171.51170.7195.34227.61

UniCare State Indemnity

Plan/PLUS

PPO-type

65.93156.7098.90235.05131.87313.39

1Survivors are not eligible for life insurance. For monthly health insurance premium cost, deduct $0.63 from monthly Retire/Survivor Pays premium.
2Elderly Governmental Retirees (EGRs) - call the GIC for monthly rates.
3CIC is an enrollee pay-all benefit.

! Contribution percentages may change after the Commonwealth’s FY16 budget is enacted.

 


This information provided by the Group Insurance Commission .

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