Page 34 - ITDR Benefits & Resources guide 2019
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2019 TRUST PLAN PREMIUMS
2019 Trust Plan Premiums
Medical and Prescription Drug Plan Premiums
Anthem Group Medicare Supplement-Type Plan
Anthem Group Medicare Advantage
2019 MONTHLY MEMBER PREMIUMS
MEDICAL
PRESCRIPTION DRUG
TOTAL MEDICAL AND RX PREMIUM*
Retiree/Surviving Spouse/Spouse
$128.89
$96.88
$225.77
Retiree + Spouse
$257.78
$193.76
$451.54
2019 MONTHLY MEMBER PREMIUMS Enhanced
MEDICAL
PRESCRIPTION DRUG
TOTAL MEDICAL AND RX PREMIUM*
Retiree/Surviving Spouse/Spouse
$50.69
$96.88
$147.57
Retiree + Spouse
$101.38
$193.76
$295.14
2019 MONTHLY MEMBER PREMIUMS Standard
MEDICAL
PRESCRIPTION DRUG
TOTAL MEDICAL AND RX PREMIUM*
Retiree/Surviving Spouse/Spouse
$14.60
$96.88
$111.48
Retiree + Spouse
$29.20
$193.76
$222.96
Premiums above do not reflect any Delta Subsidy. See the following page of this Benefit Guide, and/or your Summary of Current Elections in your enrollment packet for subsidy eligibility details.
Dental Plan Premiums
2019 MONTHLY MEMBER PREMIUMS
MEDICAL PLAN MEMBERS
DENTAL ONLY & DENTAL/VISION MEMBERS**
MetLife
Ground and Flight Attendant
Retiree/Surviving Spouse/Spouse Retiree+Spouse
$49.59 $100.28
$51.59 $102.28
Pilots
Retiree/Surviving Spouse/Spouse Retiree+Spouse
$58.72 $118.88
$60.72 $120.88
Cigna
Retiree/Surviving Spouse/Spouse Retiree+Spouse
$26.63 $53.20
$28.63 $55.20
Vision Plan Premiums
EyeMed Vision Plan Rates
2019 MONTHLY MEMBER PREMIUMS
Retiree/Surviving Spouse/Spouse
$6.21
Retiree+Spouse
$11.54
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