Department of Human Resources: 2009 DCEHBP Premium Rates

2009 DCEHBP Temporary Continuation of Coverage (TCC) Premiums

DC Employee Health Benefit Plans (Employees Hired on or After 10/01/1987)

AETNA HEALTHCARE HMO

TYPE ENROLLMENT CODE 2009 PREMIUM MONTHLY ADMINISTRATIVE FEE TOTAL

Self-Only HM1 $386.49 $7.73 $394.22

Family HM2 $1004.90 $20.10 $1025.00

DP Self HM3 $386.49 $7.73 $394.22

DP Family HM4 $1004.90 $20.10 $1025.00

AETNA QUALITY OPEN ACCESS PLAN

TYPE ENROLLMENT CODE 2009 PREMIUM MONTHLY ADMINISTRATIVE FEE TOTAL

Self-Only AP1 $522.08 $10.44 $532.52

Family AP2 $1362.64 $27.25 $1389.89

DP Self AP3 $522.08 $10.44 $532.52

DP Family AP4 $1362.64 $27.25 $1389.89

KAISER PERMANENTE HMO

TYPE	ENROLLMENT CODE	2009 PREMIUM MONTHLY	ADMINISTRATIVE FEE	TOTAL
Self-Only	KP1	$361.79	$7.24	$369.03
Family	KP2	$939.45	$18.79	$958.23
DP Self	KP3	$361.79	$7.24	$369.03
DP Family	KP4	$939.45	$18.79	$958.23

UNITED HEALTHCARE HMO

TYPE	ENROLLMENT CODE	2009 PREMIUM MONTHLY	ADMINISTRATIVE FEE	TOTAL
Self-Only	MD1	$328.40	$6.57	$334.97
Family	MD2	$851.93	$17.04	$868.97
DP Self	MD3	$328.40	$6.57	$334.97
DP Family	MD4	$851.93	$17.04	$868.97

UNITED HEALTHCARE POINT OF SERVICE

TYPE	ENROLLMENT CODE	2009 BIWEEKLY PREMIUM	2009 MONTHLY PREMIUM	TOTAL
Self-Only	UP1	$338.87	$6.78	$345.64
Family	UP2	$879.04	$17.58	$896.62
DP Self	UP3	$338.87	$6.78	$345.64
DP Family	UP4	$879.04	$17.58	$896.62