State Retiree and Survivor Non-Medicare Basic Life and Health Plan Rates

Monthly premium rates for basic life insurance and all non-Medicare health plans for state retirees and survivors

For information on how to calculate premiums for retiree and spouse coverage if under and over age 65, see the Medicare and Your GIC Benefits section.

Monthly GIC Plan Rates as of July 1, 2017

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 Monthly Retiree Pays Monthly

Retiree Pays

Monthly

Basic Life Insurance Only

($5,000 coverage)

$0.65 $0.98 $1.30

HEALTH PLAN

(Premium includes Basic Life Insurance)

PLAN TYPE

Individual Coverage Family Coverage Individual Coverage Family Coverage Individual Coverage Family Coverage

Fallon Health

Direct Care √

HMO

$55.92 $133.31 $83.89 $199.96 $111.84 $266.61

Fallon Health

Select Care (CLOSED TO NEW MEMBERS)

HMO

74.10 176.92 111.15 265.39 148.20 353.84

Harvard Pilgrim Independence

Plan (CLOSED TO NEW MEMBERS)

POS

82.79 201.06 124.18 301.59 165.57 402.12
Harvard Pilgrim Primary Choice √

HMO

62.50 151.58 93.76 227.37 125.01 303.15
Health New England √

HMO

55.27 136.07 82.92 204.12 110.55 272.15
NHP Prime (Neighborhood Health Plan)

HMO

55.86 146.96 83.80 220.45 111.72 293.92

Tufts Health Plan Navigator

(CLOSED TO NEW MEMBERS)

POS

73.28 177.87 109.93 266.81 146.56 355.74
Tufts Health Plan Spirit √

EPO (HMO-TYPE)

55.78 133.38 83.68 200.07 111.57 266.75

UniCare State Indemnity

Plan/Basic with CIC3

(Comprehensive)

Indemnity

146.32 340.63 196.07 456.63 245.81 572.62

UniCare State Indemnity

Plan/Basic without CIC

(Non-Comprehensive)

Indemnity

99.48 231.99 149.23 347.99 198.97 463.98
UniCare State Indemnity Plan/Community Choice PPO-type 52.53 125.16 78.80 187.75 105.05 250.32

UniCare State Indemnity

Plan/PLUS

PPO-type

69.73 165.69 104.60 248.53 139.46 331.37

1Survivors are not eligible for life insurance. For monthly health insurance premium cost, deduct $0.65 from monthly Retiree/Survivor Pays premium.

2Elderly Governmental Retirees (EGRs) – call the GIC for monthly rates.

3 CIC is an enrollee pay-all benefit.

√ Compare the rates of these plans and see how much you will save each month.

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