Rate Pays Highmark Delaware First State Basic Plan Aetna ...

1 State of DelawareGroup Health Insurance PlanNon-Medicare Pensioner Rates Effective July 1, 2021 Total MonthlyState PaysPensionerRatePaysHighmark Delaware First State Basic plan Individual$ $ $ & Spouse$1, $1, $ & Child(ren)$1, $1, $ $1, $1, $ CDH Gold PlanIndividual$ $ $ & Spouse$1, $1, $ & Child(ren)$1, $1, $ $1, $1, $ HMO PlanIndividual$ $ $ & Spouse$1, $1, $ & Child(ren)$1, $1, $ $1, $1, $ Delaware Comprehensive PPO PlanIndividual$ $ $ & Spouse$1, $1, $ & Child(ren)$1, $1, $ $2, $1, $ National HMO Select Dental PlanIndividual$ $ $ & Spouse$ $ $ & Child(ren)$ $ $ $ $ $ Dental PPO Plus Premier PlanIndividual$ $ $ & Spouse$ $ $ & Child(ren)$ $ $ $ $ $ Vision Care High PlanIndividual$ $ $ & Spouse$ $ $ & Child(ren)$ $ $ $ $ $ Vision Care Low PlanIndividual$ $ $ & Spouse$ $ $ & Child(ren)$ $ $ $ $ $ Pensioners Hired By The State On Or After July 1, 1991 Through December 31, 2006(The following portion of the State Share will be paid by the State )(Except those receiving a disablity pension or receiving an LTD benefit from The Hartford)Less than 10 years service0% State share paid by state10 years - less than 15 years service50% State share paid by state15 years - less than 20 years service75% State share paid by state20 years or more service100% State share paid by stateEligible Pensioners Hired By The State On Or After January 1, 2007(The following portion of the State Share will be paid by the State )(Except those receiving a disablity pension or receiving an LTD benefit from The Hartford)

2 Less than 15 years service0% State share paid by state15 years - less than years service50% State share paid by years - less than 20 years service75% State share paid by state20 years or more service100% State share paid by stateIf you have less than 20 years of service and were First hired on or after July 1, 1991,the State does not pay the full State share but will pay a percentage of the State share of thecost of your coverage as explained in the charts