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| 2010 Health Benefit Plan Premiums
DC Employee Health Benefits (Employee Hired on or After 10/01/1987)
AETNA HEALTHCARE HMO
| Self-Only |
HM1 |
$50.37 |
$109.13 |
| Family |
HM2 |
$130.95 |
$283.72 |
| Domestic Partner Self |
HM3 |
$50.37 |
$109.13 |
| Domestic Partner Family |
HM4 |
$130.95 |
$283.72 |
AETNA PPO PLAN
| Self-Only |
AP1 |
$69.00 |
$149.50 |
| Family |
AP2 |
$180.09 |
$390.20 |
| Domestic Partner Self |
AP3 |
$69.00 |
$149.50 |
| Domestic Partner Family |
AP4 |
$180.09 |
$390.20 |
KAISER PERMANENTE HMO
| Self-Only |
KP1 |
$45.10 |
$97.72 |
| Family |
KP2 |
$117.26 |
$254.06 |
| Domestic Partner Self |
KP3 |
$45.10 |
$97.72 |
| Domestic Partner Family |
KP4 |
$117.26 |
$254.06 |
UNITED HEALTHCARE HMO
| Self-Only |
MD1 |
$41.61 |
$90.14 |
| Family |
MD2 |
$107.93 |
$233.86 |
| Domestic Partner Self |
MD3 |
$41.61 |
$90.14 |
| Domestic Partner Family |
MD4 |
$107.93 |
$233.86 |
UNITED HEALTHCARE POINT OF SERVICE
| Self-Only |
UP1 |
$42.93 |
$93.02 |
| Family |
UP2 |
$111.37 |
$241.30 |
| Domestic Partner Self |
UP3 |
$42.93 |
$93.02 |
| Domestic Partner Family |
UP4 |
$111.37 |
$241.30 |
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