Health Plan Premium Rates for Employees and Retirees without Medicare

Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
    2025
Program Option
    Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits

Health Plan Premium Rates For Employees and Retirees without Medicare

Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.
Plan Year
    2025
Program Option
    Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits

Health Plan Premium Rates For Employees and Retirees without Medicare

Your employer may pay a portion of your health care premium if you're employed. This page lists the full premium amounts, which is the amount before any employer contribution.

Program Option
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Plan Year
  • 2025

Find the Cost of Your Drugs

Employees and Retirees without Medicare: learn how much you can expect to pay at the pharmacy.

Program Option
  • Local Annuitant Health Program (LAHP)
  • Local Deductible Health Plan (PO14) & Supplemental Benefits
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
  • Local Health Plan (PO16) & Supplemental Benefits
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
Plan Year
  • 2025

Find the Cost of Your Drugs (Medicare)

Retirees with Medicare: learn how much you can expect to pay at the pharmacy.

Program Option
  • Local Annuitant Health Program (LAHP)
  • Local Deductible Health Plan (PO14) & Supplemental Benefits
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
  • Local Health Plan (PO16) & Supplemental Benefits
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
  • State Employee and Retiree Health Plan & Supplemental Benefits
Plan Year
  • 2025
ET-4427
Form Active Employee / Retiree / Other Benefit Recipient

Statement of Incapacity for Finances and Property

Form for the member’s physician to complete if the member cannot manage property, finances or business affairs because of an impairment in the ability to receive and evaluate information or make or communicate decisions even with the use of technological assistance.

Find the Cost of Your Drugs

Employees and Retirees without Medicare: learn how much you can expect to pay at the pharmacy.

Program Option
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Plan Year
  • 2025