2021 Monthly insurance premiums for funded retirees - South Carolina

2021 Monthly insurance premiums for funded retirees

Rates may vary for optional employers. Verify rates with your benefits office.

Retiree eligible for Medicare, spouse eligible for Medicare

Medicare Supplemental1,2 Carve-out Plan1 Dental Plus Basic Dental State Vision Plan Tobacco-use premium1

Retiree $97.68 $79.68 $25.96 $0.00 $5.80 $40.00

Retiree/spouse $253.36 $217.36 $60.12 $7.64 $11.60 $60.00

Retiree/children $143.86 $125.86 $74.26 $13.72 $12.46 $60.00

Full family $306.56 $270.56 $99.98 $21.34 $18.26 $60.00

Retiree eligible for Medicare, spouse not eligible for Medicare

Medicare Supplemental1,2 Carve-out Plan1 Dental Plus Basic Dental State Vision Plan Tobacco-use premium1

Retiree/spouse $253.36 $235.36 $60.12 $7.64 $11.60 $60.00

Full family $299.54 $281.54 $99.98 $21.34 $18.26 $60.00

Retiree not eligible for Medicare, spouse eligible for Medicare

Medicare Supplemental1,2 Carve-out Plan1 Dental Plus Basic Dental State Vision Plan Tobacco-use premium1

Retiree/spouse $253.36 $235.36 $60.12 $7.64 $11.60 $60.00

Full family $299.54 $281.54 $99.98 $21.34 $18.26 $60.00

1State Health Plan subscribers who use tobacco or e-cigarettes or cover dependents who use tobacco or e-cigarettes will pay a $40 per month premium for subscriber-only coverage. The premium is $60 for other levels of coverage. The premium is automatic for all State Health Plan subscribers unless the subscriber certifies no one he covers uses tobacco or e-cigarettes, or covered individuals who use tobacco or e-cigarettes have completed the Quit For Life? tobacco cessation program.

2If the Medicare Supplemental Plan is elected, claims for covered subscribers not eligible for Medicare will be based on the Standard Plan provisions.

SCPEBA 092020 | Expires 12312021 Data classification: public information

Retiree not eligible for Medicare, spouse not eligible for Medicare

Standard Plan1 Savings Plan1 TRICARE Supplement Dental Plus Basic Dental State Vision Plan Tobacco-use premium1

Retiree $97.68 $9.70 $62.50 $25.96 $0.00 $5.80 $40.00

Retiree/spouse $253.36 $77.40 $121.50 $60.12 $7.64 $11.60 $60.00

Retiree/children $143.86 $20.48 $121.50 $74.26 $13.72 $12.46 $60.00

Full family $306.56 $113.00 $162.50 $99.98 $21.34 $18.26 $60.00

Retiree not eligible for Medicare, spouse not eligible for Medicare, one or more children eligible for Medicare

Medicare Supplemental1,2 Carve-out Plan1 Dental Plus Basic Dental State Vision Plan Tobacco-use premium1

Retiree/children $161.86 $143.86 $74.26 $13.72 $12.46 $60.00

Full family $324.56 $306.56 $99.98 $21.34 $18.26 $60.00

1State Health Plan subscribers who use tobacco or e-cigarettes or cover dependents who use tobacco or e-cigarettes will pay a $40 per month premium for subscriber-only coverage. The premium is $60 for other levels of coverage. The premium is automatic for all State Health Plan subscribers unless the subscriber certifies no one he covers uses tobacco or e-cigarettes, or covered individuals who use tobacco or e-cigarettes have completed the Quit For Life? tobacco cessation program.

2If the Medicare Supplemental Plan is elected, claims for covered subscribers not eligible for Medicare will be based on the Standard Plan provisions.

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