Medical plan premiums

Medical plan premiums

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

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

2022

Kaiser Permanente NW

Plans	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
1	$50	$100	$88	$150
2	$69	$138	$121	$207
3	$136	$272	$238	$408

Kaiser Permanente WA

Plans	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
Core 1	$39	$78	$68	$117
Core 2	$44	$88	$77	$132
Core 3	$119	$238	$208	$357
SoundChoice	$76	$152	$133	$228
Options Access PPO 1	$104	$208	$182	$312
Options Access PPO 2	$133	$266	$233	$399
Options Access PPO 3	$185	$370	$324	$555

Premera

Plans	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
High PPO	$87	$174	$152	$261
Peak Care EPO	$41	$82	$72	$123
Standard PPO	$37	$74	$65	$111

Uniform Medical Plan (UMP)

Plans	Employee	Employee and spouse/SRDP	Employee and children	Employee, spouse/SRDP, and children
UMP Achieve 1	$37	$74	$65	$111
UMP Achieve 2	$101	$202	$177	$303
UMP High Deductible (with a health savings account)	$25	$50	$44	$75
UMP Plus–Puget Sound High Value Network	$77	$154	$135	$231
UMP Plus–UW Medicine Accountable Care Network	$77	$154	$135	$231

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.

• 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.

For more details, visit Surcharges.

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.