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| 2009 Health Benefit Plan Premiums
DC Employee Health Benefits (Employee Hired on or After 10/01/1987)
AETNA HEALTHCARE HMO
| Self-Only |
HM1 |
$44.60 |
$96.63 |
| Family |
HM2 |
$115.95 |
$251.23 |
| Domestic Partner Self |
HM3 |
$44.60 |
$96.63 |
| Domestic Partner Family |
HM4 |
$115.95 |
$251.23 |
AETNA QUALITY OPEN ACCESS PLAN
| Self-Only |
AP1 |
$60.24 |
$130.52 |
| Family |
AP2 |
$157.23 |
$340.66 |
| Domestic Partner Self |
AP3 |
$60.24 |
$130.52 |
| Domestic Partner Family |
AP4 |
$157.23 |
$340.66 |
KAISER PERMANENTE HMO
| Self-Only |
KP1 |
$41.75 |
$90.46 |
| Family |
KP2 |
$108.40 |
$234.87 |
| Domestic Partner Self |
KP3 |
$41.75 |
$90.46 |
| Domestic Partner Family |
KP4 |
$108.40 |
$234.87 |
UNITED HEALTHCARE HMO
| Self-Only |
MD1 |
$37.89 |
$82.10 |
| Family |
MD2 |
$98.30 |
$212.98 |
| Domestic Partner Self |
MD3 |
$37.89 |
$82.10 |
| Domestic Partner Family |
MD4 |
$98.30 |
$212.98 |
UNITED HEALTHCARE POINT OF SERVICE
| Self-Only |
UP1 |
$39.10 |
$84.72 |
| Family |
UP2 |
$101.43 |
$219.77 |
| Domestic Partner Self |
UP3 |
$39.10 |
$84.72 |
| Domestic Partner Family |
UP4 |
$101.43 |
$219.77 |
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