Rates
Rates and Coverage details shown are for Current and Former Employees of the OPEH&W
Health Plan for the 2020/21 plan year which runs from 7/1/2020 through 6/30/2021.

Contents
 》All-in-One Rate Sheet PDF
 》Health
 》Dental
 》Vision
 》Group Life
 》Additional Life

Health
Health Coverage Details
  Diamond Platinum Gold Silver Bronze
Member 603.60 561.94 528.76 498.58 469.00
Child 294.14 273.86 257.68 242.98 228.56
Children 478.84 445.80 419.48 395.54 372.08
Spouse 719.84 670.18 630.58 594.60 559.34
Spouse & Child 1,013.98 1,115.98 1,050.06 990.14 931.42
Spouse & Children    1,198.68 1,138.30 1,071.06 1,009.96 950.04
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Dental
Dental Coverage Details
Coverage Tier Enhanced Standard
Member 42.36 38.12
Child 22.82 20.54
Children 36.28 32.66
Spouse 53.36 48.02
Spouse & Child 76.18 68.56
Spouse & Children 89.64 80.68
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Vision
Vision Coverage Details
Coverage Tier Enhanced Standard
Member 7.74 6.28
Child 7.22 5.82
Children 7.22 5.82
Spouse 6.80 5.50
Spouse & Child 18.44 14.92
Spouse & Children     18.44 14.92
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Group Life
Group Life Coverage Details
Death Benefit          Rate
20,000 6.00
30,000 9.00
40,000 12.00
50,000 15.00
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Additional Life
Additional Life Coverage Details
Per $5,000 of Coverage
         18-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
With AD&D 0.50 0.65 0.85 1.30 2.10 3.35 3.85 6.20 10.40 16.05
Without AD&D 0.35 0.50 0.70 1.15 1.95 3.20 3.70 6.05 10.25 15.90
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