NMRHCA Pre-55 Retirement Age Medical Plan
Monthly Premium Contributions
January 1, 2027 – December 31, 2027
Applicable for members who retired before age 55 and whose retirement date is July 31, 2021, or after.
Non-Medicare Plans
| Plan | Retiree Rate | Spouse Rate | Child Rate |
|---|---|---|---|
| Premier PPO (BCBS or Presbyterian) | $1,029.04 | $1,098.63 | $366.66 |
| Value Plan (BCBS or Presbyterian) | $803.83 | $858.14 | $285.93 |
Rate Calculation Instructions
Medicare Plans (Not Applicable for Pre-55 Members)
| Plan | Retiree Rate | Spouse Rate | Child Rate |
|---|---|---|---|
| BCBS Medicare Supplement PPO | N/A | N/A | N/A |
| BCBS Medicare Advantage HMO | N/A | N/A | N/A |
| BCBS Medicare Advantage PPO | N/A | N/A | N/A |
| Humana Medicare Advantage PPO + PDP | N/A | N/A | N/A |
| United Healthcare Medicare Advantage PPO + PDP | N/A | N/A | N/A |
Dental Plan Monthly Premiums
Effective January 1, 2027 – December 31, 2027
| Plan | Single | Two-Party | Family |
|---|---|---|---|
| BCBS Dental Basic | $19.98 | $37.95 for both | $56.93 for all |
| BCBS Dental Comprehensive | $38.46 | $73.07 for both | $109.56 for all |
| Delta Dental Basic | $24.04 | $45.68 for both | $68.51 for all |
| Delta Dental Comprehensive | $45.67 | $86.79 for both | $130.18 for all |
Vision Plan Monthly Premiums
Effective January 1, 2025 – June 30, 2028
| Plan | Single | Two-Party | Family |
|---|---|---|---|
| Davis Vision | $4.91 | $9.24 for both | $13.61 for all |
Dependent Child Life Insurance Monthly Premiums
Effective July 1, 2019 – June 30, 2027 — The Standard Insurance
| Coverage Amount | Monthly Premium (covers all children) |
|---|---|
| $2,500 | $4.13 for all |
| $5,000 | $7.75 for all |
| $10,000 | $15.00 for all |
Retiree / Spouse Supplemental Life Insurance Monthly Premiums
Effective September 1, 2023 – June 30, 2027 — The Standard
Rates marked with ** require an Evidence of Insurability Statement to add or increase coverage.
Showing all age bands.
Coverage $2,000 to $10,000
| Age Band | $2,000 | $4,000 | $6,000 | $8,000 | $10,000 |
|---|---|---|---|---|---|
| Age 35–39 | $0.70 | $0.90 | $1.09 | $1.29 | $1.49 |
| Age 40–44 | $0.82 | $1.14 | $1.45 | $1.77 | $2.09 |
| Age 45–49 | $1.03 | $1.57 | $2.10 | $2.64 | $3.17 |
| Age 50–54 | $1.43 | $2.36 | $3.29 | $4.22 | $5.15 |
| Age 55–59 | $2.04 | $3.58 | $5.13 | $6.67 | $8.21 |
| Age 60–64 | $2.38 | $4.26 | $6.14 | $8.02 | $9.90 |
| Age 65–69 | $4.36 | $8.21 | $12.07 | $15.92 | $19.78 |
| Age 70 and over | $6.41 | $12.32 | $18.24 | $24.15 | $30.06 |
Coverage $15,000 to $60,000
| Age Band | $15,000** | $20,000** | $40,000** | $46,000** | $60,000** |
|---|---|---|---|---|---|
| Age 35–39 | $1.99 | $2.48 | $4.46 | $5.05 | $6.44 |
| Age 40–44 | $2.89 | $3.68 | $6.86 | $7.81 | $10.04 |
| Age 45–49 | $4.51 | $5.84 | $11.18 | $12.78 | $16.52 |
| Age 50–54 | $7.48 | $9.80 | $19.10 | $21.89 | $28.40 |
| Age 55–59 | $12.07 | $15.92 | $31.34 | $35.97 | $46.76 |
| Age 60–64 | $14.60 | $19.30 | $38.10 | $43.74 | $56.90 |
| Age 65–69 | $29.42 | $39.06 | $77.62 | $89.19 | $116.18 |
| Age 70 and over | $44.84 | $59.62 | $118.74 | $136.48 | $177.86 |
* This is optional coverage and the entire cost is paid by you. Cost of insurance for all coverages paid by you may increase or decrease in the future based upon the claims experience of participants. All provisions that apply to this coverage are governed by the Certificate. Life plan rates include a $0.50 administration fee.
** An Evidence of Insurability Statement is required to add or increase life insurance. The Change for Additional Life Insurance form can be found at www.nmrhca.org/forms.aspx.