Department of Human Resources: 2010 DCEHBP TCC PREMIUMS

2010 DCEHBP Temporary Continuation of Coverage (TCC) Premiums

DC Employee Health Benefits (Employees Hired on or After 10/01/1987)

AETNA HEALTHCARE HMO

TYPE ENROLLMENT CODE 2010 PREMIUM MONTHLY ADMINISTRATIVE FEE TOTAL

Self HM1 $436.50 $8.73 $445.23

Family HM2 $1134.90 $22.70 $1157.60

DP Self HM3 $436.90 $8.73 $445.23

DP Family HM4 $1134.90 $22.70 $1157.60

AETNA PPO PLAN

TYPE	ENROLLMENT CODE	2010 PREMIUM MONTHLY	ADMINISTRATIVE FEE	TOTAL
Self	AP1	$598.00	$11.96	$609.96
Family	AP2	$1560.78	$31.22	$1592.00
DP Self	AP3	$598.00	$11.96	$609.96
DP Family	AP4	$1560.78	$31.22	$1592.00

KAISER PERMANENTE HMO

TYPE	ENROLLMENT CODE	2010 PREMIUM MONTHLY	ADMINISTRATIVE FEE	TOTAL
Self-Only	KP1	$390.86	$7.82	$398.68
Family	KP2	$1016.23	$20.32	$1036.55
DP Self	KP3	$390.86	$7.82	$398.68
DP Family	KP4	$1016.23	$20.32	$1036.55

UNITED HEALTHCARE HMO

TYPE	ENROLLMENT CODE	2010 PREMIUM MONTHLY	ADMINISTRATIVE FEE	TOTAL
Self-Only	MD1	$360.58	$7.21	$367.79
Family	MD2	$935.42	$18.71	$954.13
DP Self	MD3	$360.58	$7.21	$367.79
DP Family	MD4	$935.42	$18.71	$954.13

UNITED HEALTHCARE POINT OF SERVICE

TYPE	ENROLLMENT CODE	2010 PREMIUM MONTHLY	ADMINISTRATIVE FEE	TOTAL
Self-Only	UP1	$372.08	$7.44	$379.52
Family	UP2	$965.19	$19.30	$984.49
DP Self	UP3	$372.08	$7.44	$379.52
DP Family	UP4	$965.19	$19.30	$984.49