2013 PEBB Employee Benefit Plans Monthly Premium Rates

Medical Plans
Employee PEBB Statewide PPO1 Providence Choice2 Kaiser3 Kaiser Deductible3 PEBB Statewide Part-time PPO4 Providence Choice Part-time5 Kaiser Part-time6 Kaiser Deductible Part-Time6
1 2

Employee & Spouse/Partner

$1,426.70 1,257.90 1,361.57 1,251.87 1,142.72 1,003.13 1,152.65 1,088.64

Employee & Children

$1,224.45 1,079.58 1,168.54 1,074.38 980.73 860.94 989.22 934.30

Employee & Family

$1,458.64 1,286.08 1,392.06 1,279.92 1,168.33 1,025.61 1,178.45 1,113.01

$1,064.82 938.76 1,016.10 934.25 852.86 748.63 860.18 812.42

Available to PEBB eligible full-time and part-time employees. VSP routine vision services. Available to PEBB eligible full-time and part-time employees in plan service area. VSP routine vision services. 3 Available to PEBB eligible full-time and part-time employees in plan service area. Kaiser routine vision services. 4 Additional option available to eligible part-time employees. No vision benefit. 5 Additional option available to eligible part-time employees in plan service area. No vision benefit. 6 Additional option available to eligible part-time employees in plan service area. Vision exam only.

Dental Plans
Employee ODS Preferred 1 ODS Traditional 2 Kaiser Permanente 3 Willamette Dental Group4 ODS Part-time5 Kaiser Permanente Part-time6
1 2

$78.15 84.60 78.95 75.37 60.88 58.81

Employee & Spouse/Partner $104.73 113.38 105.80 101.00 81.57 78.80

Employee & Children $89.87 97.30 90.79 86.67 70.02 67.64

Employee & Family $107.08 115.91 108.16 103.26 83.40 80.60

Available to PEBB eligible full-time and part-time employees. Available to PEBB eligible full-time and part-time employees. 3 Available to PEBB eligible full-time and part-time employees in plan service area. 4 Additional option available to eligible part-time employees. 5 Additional option available to eligible part-time employees in plan service area. 6 Additional option available to eligible part-time employees; in plan facilities.

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