Ｘ
The charts below list the amounts you will pay per month for coverage. Benefit deductions will be withheld based on 24 pay periods per year.
MEDICAL
All States — Blue Shield Savings Plus PPO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $40 |
| You + Spouse | $80 |
| You + Child(ren) | $75 |
| You + Family | $160 |
CA — Blue Shield PPO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $280 |
| You + Spouse | $470 |
| You + Child(ren) | $460 |
| You + Family | $720 |
Non-CA — Blue Shield PPO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $100 |
| You + Spouse | $200 |
| You + Child(ren) | $190 |
| You + Family | $400 |
Non-CA — Blue Shield EPO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $60 |
| You + Spouse | $120 |
| You + Child(ren) | $110 |
| You + Family | $240 |
CA — Blue Shield HMO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $40 |
| You + Spouse | $80 |
| You + Child(ren) | $75 |
| You + Family | $160 |
CA and WA — Kaiser Permanente HMO. Only for current enrollees. Not available for new enrollment.
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $40 |
| You + Spouse | $80 |
| You + Child(ren) | $75 |
| You + Family | $160 |
Dental
All States – Cigna HMO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $0 |
| You + Spouse | $10 |
| You + Child(ren) | $10 |
| You + Family | $20 |
All States – Cigna PPO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $10 |
| You + Spouse | $20 |
| You + Child(ren) | $25 |
| You + Family | $40 |
All States – Cigna PPO Buy-Up
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $18 |
| You + Spouse | $35 |
| You + Child(ren) | $42 |
| You + Family | $64 |
Vision
All States – EyeMed PPO
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $0 |
| You + Spouse | $10 |
| You + Child(ren) | $10 |
| You + Family | $15 |
All States – EyeMed PPO Buy-Up
| Level of Coverage | Your Monthly Premium |
|---|---|
| You | $2 |
| You + Spouse | $12.50 |
| You + Child(ren) | $13.50 |
| You + Family | $20 |
Voluntary Life and AD&D Insurance
Check out the Voluntary Life and AD&D Rate Sheet to see the monthly rates for yourself and for spouse coverage.
Voluntary Supplemental Medical Insurance
You can find the cost for voluntary accident, critical illness, and hospital indemnity insurance on the Aflac Voluntary Insurance Rate Sheet.
