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School board member premiums

Full benefits package premiums

 Premiums are effective January 1, 2021 through December 31, 2021. Premiums reflect how much PEBB will charge the employer. The employer determines what portion of the rates the employee pays.

Medical plan

Subscriber

Subscriber and spouse1 Subscriber and children Subscriber, spouse1, and children

Kaiser Permanente NW2 Classic

$895.71

$1,635.80 $1,450.78 $2,190.87

Kaiser Permanente NW2 Consumer-Directed Health Plan (CDHP)

$768.81

$1,376.35 $1,239.05 $1,788.26
Kaiser Permanente WA Classic $925.44 $1,695.27 $1,502.81 $2,272.63
Kaiser Permanente WA CDHP $769.34 $1,377.91 $1,240.35 $1,790.59
Kaiser Permanente WA SoundChoice $791.48 $1,427.33 $1,268.37 $1,904.22
Kaiser Permanente WA Value $849.01 $1,542.39 $1,369.05 $2,062.43
Uniform Medical Plan (UMP) Classic $841.77 $1,527.91 $1,356.37 $2,042.52
UMP Select $773.55 $1,391.48 $1,237.00 $1,854.93
UMP CDHP $768.57 $1,376.36 $1,239.00 $1,788.46
UMP Plus—Puget Sound High Value Network $808.84 $1,462.07 $1,298.76 $1,951.98
UMP Plus—UW Medicine Accountable Care Network $808.84 $1,462.07 $1,298.76 $1,951.98

1 Or state-registered domestic partner.

2 Kaiser Foundation Health Plan of the Northwest offers plans in Clark and Cowlitz counties in Washington and select counties in Oregon.

Surcharges in addition to medical plan premiums

Employees may have to pay monthly surcharges in addition to the medical plan premium.

Surcharge

Subscriber only

Subscriber and spouse1 Subscriber and children

Subscriber, spouse, and children1

Tobacco use surcharge

$25.00

$25.00 $25.00 $25.00

Spouse waiver (AV) surcharge

$0.00

$50.00 $0.00 $50.00

1 Or state-registered domestic partner.

Contact

Phone: 1-800-700-1555