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

Monthly GIC Plan Rates Effective July 1, 2015

 

Medicare
Retirees
Retired on or before
07/01/1994 and survivors 1, 2

Medicare Retirees Retired after 07/01/1994 and who filed for retirement on or after 08/10/2009 and on or before 10/01/2009

Medicare Retirees who filed for retirement after
10/01/2009

 

10%

15%

20%

 

Retiree/Survivor Pays Monthly

Retiree 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)

Per Person

Per Person

Per Person

Fallon Senior
Plan 3
(HMO)

$30.72

$46.09

$61.45

Harvard Pilgrim Medicare
Enhance
(Indemnity)

39.70

59.55

79.40

Health
New England MedPlus
(HMO)

36.58

54.88

73.16

Tufts Health Plan Medicare Complement
(HMO)

35.88

53.83

71.76

Tufts Health Plan Medicare
Preferred 3
(HMO)

28.08

42.13

56.16

UniCare State Indemnity Plan/Medicare Extension (OME) with CIC 4
(Comprehensive)
(Indemnity)

50.29

70.21

90.11

UniCare State Indemnity Plan/Medicare Extension (OME) without CIC (Non-Comprehensive)
(Indemnity)

39.82

59.74

79.64

1 Survivors are not eligible for life insurance. For monthly health insurance premium cost, deduct $0.63 from monthly Retiree/Survivor Pays premium.
2 Elderly Governmental Retirees (EGRs) - call the GIC for monthly rates.
3Benefits and rates of Fallon Senior Plan and Tufts Health Plan Medicare Preferred are subject to federal approval and may change January 1, 2016.

4 CIC 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 .