PRE-65 RETIREE CONTRIBUTIONS Pre-65 Retiree Medical Plan Monthly Premiums OAP IN-NETWORK PLUS Option Retiree $299.56 Retiree + 1 $599.11 Family $835.76 OAP BASIC Option Retiree $271.87 Retiree + 1 $543.73 Family $758.49 CHOICE FUND HRA Option Retiree $246.27 Retiree + 1 $492.52 Family $687.07 Dental Plan Monthly Premiums DPPO ($1,500) Option Retiree $25.79 Retiree + 1 $54.17 Family $77.38 Vision Plan Monthly Premiums Retiree $5.10 Retiree + 1 $9.77 Family $15.84 POST-65 RETIREE CONTRIBUTIONS Medicare Surround & Part D Prescription Drug Plan - Monthly Premiums Classified or 15-19 20 29 30 Plus of – Less than 15 Years of Service Years of Service Service Years of Service ($25 credit) ($37.50 credit) ($50 credit) Retiree with $195.48 $170.48 $157.98 $145.48 Medicare
PRE-65 RETIREE CONTRIBUTIONS Pre-65 Retiree Medical Plan Monthly Premiums OAP IN-NETWORK PLUS Option Retiree Retiree + 1 Family $299.56 $599.11 $835.76 OAP BASIC Option Retiree Retiree + 1 Family $271.87 $543.73 $758.49 CHOICE FUND HRA Option Retiree Retiree + 1 Family $246.27 $492.52 $687.07 Dental Plan Monthly Premiums DPPO ($1,500) Option Retiree Retiree + 1 Family $25.79 $54.17 $77.38 Vision Plan Monthly Premiums Retiree Retiree + 1 Family $5.10 $9.77 $15.84 POST-65 RETIREE CONTRIBUTIONS Medicare Surround & Part D Prescription Drug Plan - Monthly Premiums Classified or Less than 15 Years of Service 15-19 Years of Service ($25 credit) 20 – 29 Years of Service ($37.50 credit) 30 Plus of Service ($50 credit) Retiree with Medicare $195.48 $170.48 $157.98 $145.48
SCS%20Pre%2065%20and%20Post-65%20Retiree%20Booklet%202019%20revised%201.docx