Retire Health & Welfare Rates

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Disability Pensioners

All Other Pensioners

Retiree Health & Welfare
Plan Monthly Fees

DISABILITY PENSIONERS ONLY
(Until age 65 - then Regular rates apply)

"Full Fee-for-Service Plan"

HMO + DeltaPMI Plan

Limited Plan

"M" PLAN**

Single Coverage (No dependents):
If you have Medicare	73.00	n/a	38.00	23.00
If you DO NOT have Medicare	132.00	94.00	38.00	N/A
Two-Party (2 family Medicare)
If BOTH have Medicare with Plan "M"	n/a	n/a	n/a	45.00
If BOTH have Medicare without Plan "M"	145.00	n/a	152.00	n/a
If ONE has Medicare with Plan "M"	154.00	117.00	61.00	154.00
If ONE has Medicare without Plan "M"	204.00	n/a	152.00	n/a
If both DO NOT have Medicare	263.00	188.00	152.00	n/a
Family coverage (3+ family members);
If TWO have Medicare with Plan "M"	111.00	92.00	64.00	111.00
If TWO have Medicare without Plan "M"	211.00	n/a	95.00	n/a
If ONE has Medicare with Plan "M"	220.00	164.00	80.00	220.00
If ONE has Medicare without Plan "M"	270.00	n/a	95.00	n/a
If NO ONE has Medicare	329.00	235.00	95.00	n/a

ALL OTHER PENSIONERS

"Full Fee-for-Service Plan"

HMO + DeltaPMI Plan

Limited Plan

Plan "M"

Single Coverage (No dependents):
If you have Medicare	145.00	n/a	76.00	45.00
If you DO NOT have Medicare	263.00	188.00	76.00	n/a
Two-Party (2 family members):
If BOTH have Medicare with Plan "M"	n/a	n/a	n/a	90.00
If BOTH have Medicare without Plan "M"	290.00	n/a	152.00	n/a
If ONE has Medicare with Plan "M"	308.00	233.00	121.00	308.00
If ONE has Medicare without Plan "M"	408.00	n/a	152.00	n/a
If both DO NOT have Medicare	526.00	376.00	152.00	n/a
Family coverage (3+ family members);
If TWO have Medicare with Plan "M"	222.00	184.00	128.00	222.00
If TWO have Medicare without Plan "M"	422.00	n/a	190.00	n/a
If ONE has Medicare with Plan "M"	440.00	327.00	121.00	440.00
If ONE has Medicare without Plan "M"	540.00	n/a	190.00	n/a
If NO ONE has Medicare	658.00	470.00	190.00	n/a
Retirees earning over $30,000 per year:
Excluding Nevada residents	940.00	940.00	940.00	n/a
Nevada residents only	955.00	955.00	955.00	n/a

*The "STAY ACTIVE" Plan is restricted to non-Medicare participants and can only be selected when you first retire. The Plan includes the higher inpatient hospital benefits and routine physical exam benefits provided to Active participants. Life Insurance is not included; the Retiree is eligible for the $2,500 Death Benefit provided by the Retiree Plan.

**The "M" Plan is restricted to Medicare participants who enroll in Medicare HMOs. The participant must submit evidence of coverage from the HMO with enrollment. The Fund pays limited benefits.