Medical plan premiums

Medical plan premiums

2024

Kaiser Permanente NW

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
Kaiser Permanente NW 1	$67	$134	$117	$201
Kaiser Permanente NW 2	$105	$210	$184	$315
Kaiser Permanente NW 3	$196	$392	$343	$588

Kaiser Permanente WA

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
Kaiser Permanente WA Core 1	$48	$96	$84	$144
Kaiser Permanente WA Core 2	$98	$196	$172	$294
Kaiser Permanente WA Core 3	$149	$298	$261	$447
Kaiser Permanente WA SoundChoice	$115	$230	$201	$345
Kaiser Permanente WA Options Summit PPO 1	$100	$200	$175	$300
Kaiser Permanente WA Options Summit PPO 2	$143	$286	$250	$429
Kaiser Permanente WA Options Summit PPO 3	$237	$474	$415	$711

Premera Blue Cross

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
Premera High PPO	$115	$230	$201	$345
Premera HMO	$20	$40	$35	$60
Premera Standard PPO	$64	$128	$112	$192

Uniform Medical Plan (UMP)

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
UMP Achieve 1	$44	$88	$77	$132
UMP Achieve 2	$113	$226	$198	$339
UMP High Deductible	$21	$42	$37	$63
UMP Plus–PSHVN	$86	$172	$151	$258
UMP Plus–UW Medicine ACN	$86	$172	$151	$258

2023

Kaiser Permanente NW

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
Kaiser Permanente NW 1	$31	$62	$54	$93
Kaiser Permanente NW 2	$57	$114	$100	$171
Kaiser Permanente NW 3	$89	$178	$156	$267

Kaiser Permanente WA

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
Kaiser Permanente WA Core 1	$38	$76	$67	$114
Kaiser Permanente WA Core 2	$43	$86	$75	$129
Kaiser Permanente WA Core 3	$120	$240	$210	$360
Kaiser Permanente WA SoundChoice	$74	$148	$130	$222
Kaiser Permanente WA Options Summit PPO 1	$77	$154	$135	$231
Kaiser Permanente WA Options Summit PPO 2	$106	$212	$186	$318
Kaiser Permanente WA Options Summit PPO 3	$142	$284	$249	$426

Premera Blue Cross

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
Premera Blue Cross High PPO	$97	$194	$170	$291
Premera Blue Cross HMO	$25	$50	$44	$75
Premera Blue Cross Standard PPO	$49	$98	$86	$147

Uniform Medical Plan (UMP)

Plan	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
UMP Achieve 1	$42	$84	$74	$126
UMP Achieve 2	$105	$210	$184	$315
UMP High Deductible	$28	$56	$49	$84
UMP Plus–PSHVN	$83	$166	$145	$249
UMP Plus–UW Medicine ACN	$83	$166	$145	$249

Before you enroll

1. Make sure you live in the plan's service area.
2. Contact the plan or check the plan's provider director to make sure your providers are in the plan's network.

Surcharges in addition to medical plan premiums

You will pay the following surcharges in addition to your monthly medical premium if they apply to you. For more details, visit Surcharges.

• A $25-per-account surcharge will apply if you or any dependent enrolled in SEBB medical coverage uses tobacco products.
• A $50 surcharge will apply if you enroll your spouse or state-registered domestic partner in SEBB medical coverage and your spouse or domestic partner has chosen not to enroll in other employer-based group medical insurance that is comparable to the PEBB Program's Uniform Medical Plan (UMP) Classic.

Premiums for other benefits

There are no employee premiums for dental, vision, basic life, basic accidental death and dismemberment (AD&D) insurance, and employer-paid long-term (LTD) disability insurance benefits.

How to pay

You pay for coverage with pretax dollars from your paycheck under the state's premium payment plan.

For details and contact information, see How do I pay? on the Paying for benefits page.