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Medical plan premiums

Find out the monthly cost of your medical plan.

Medical plan premiums

2021

Kaiser Permanente NW

Plans	Employee	Employee and spouse²	Employee and children	Employee, spouse², and children
1	$39	$78	$68	$117
2	$52	$104	$91	$156
3	$119	$238	$208	$357

Kaiser Permanente WA

Plans	Employee	Employee and spouse²	Employee and children	Employee, spouse², and children
Core 1	$16	$32	$28	$48
Core 2	$21	$42	$37	$63
Core 3	$91	$182	$159	$273
SoundChoice	$51	$102	$89	$153
Options Access PPO 1	$66	$132	$116	$198
Options Access PPO 2	$97	$194	$170	$291
Options Access PPO 3	$146	$292	$256	$438

Plans	Employee	Employee and spouse²	Employee and children	Employee, spouse², and children
High PPO	$76	$152	$133	#228
Peak Care EPO	$37	$74	$65	$111
Standard PPO	$28	$56	$49	$84

Plans	Employee	Employee and spouse²	Employee and children	Employee, spouse², and children
UMP Achieve 1	$33	$66	$58	$99
UMP Achieve 2	$98	$196	$172	$294
UMP High Deductible (with a health savings account)	$25	$50	$44	$75
UMP Plus—Puget Sound High Value Network	$68	$136	$119	$204
UMP Plus—UW Medicine Accountable Care Network	$68	$136	$119	$204

¹UMP is administered by Regence BlueShield and Washington State Rx Services (WSRxS).
² Or state-registered domestic partner.

2020

Kaiser Permanente NW

Plans	Employee	Employee and spouse²	Employee and child(ren)	Employee, spouse², and child(ren)
1	$28	$56	$49	$84
2	$41	$82	$72	$123
3	$106	$212	$186	$318

Kaiser Permanente WA

Plans	Employee	Employee and spouse²	Employee and child(ren)	Employee, spouse², and child(ren)
Core 1	$13	$26	$23	$39
Core 2	$19	$38	$33	$57
Core 3	$89	$178	$156	$267
SoundChoice	$49	$98	$86	$147
Options Access PPO 1	$39	$78	$68	$117
Options Access PPO 2	$69	$138	$121	$207
Options Access PPO 3	$116	$232	$203	$348

Plans	Employee	Employee and spouse²	Employee and child(ren)	Employee, spouse², and child(ren)
High PPO	$70	$140	$123	$210
Peak Care EPO	$31	$62	$54	$93
Standard PPO	$22	$44	$39	$66

Plans	Employee	Employee and spouse²	Employee and child(ren)	Employee, spouse², and child(ren)
UMP Achieve 1	$33	$66	$58	$99
UMP Achieve 2	$98	$196	$172	$294
UMP High Deductible (with a health savings account)	$25	$50	$44	$75
UMP Plus—Puget Sound High Value Network	$68	$136	$119	$204
UMP Plus—UW Medicine Accountable Care Network	$68	$136	$119	$204

¹UMP is administered by Regence BlueShield and Washington State Rx Services (WSRxS).
² or state-registered domestic partner.

Before you enroll

Make sure you live in the plan's service area.
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 and accidental death and dismemberment (AD&D) insurance, and basic long-term (LTD) disability insurance benefits.