LAPRA Retiree 2018-2019 Medical & Dental Premium Rates

6 Your Cost for Dental Coverage Your cost for dental is the member rate minus the Pension Department subsidy based on your age (minimum: age 55) and years of service (minimum: 10 years). Anthem Blue Cross - PPO Dental Monthly Premium Rates, Subsidy and Member Costs Single 2-Party Family Years of Service Member Rate Subsidy Member Cost Member Rate Subsidy Member Cost Member Rate Subsidy Member Cost < 10 $74.80 $0.00 $74.80 $109.80 $0.00 $109.80 $118.80 $0.00 $118.80 10 $74.80 $17.84 $56.96 $109.80 $17.84 $91.96 $118.80 $17.84 $100.96 11 $74.80 $19.62 $55.18 $109.80 $19.62 $90.18 $118.80 $19.62 $99.18 12 $74.80 $21.41 $53.39 $109.80 $21.41 $88.39 $118.80 $21.41 $97.39 13 $74.80 $23.19 $51.61 $109.80 $23.19 $86.61 $118.80 $23.19 $95.61 14 $74.80 $24.98 $49.82 $109.80 $24.98 $84.82 $118.80 $24.98 $93.82 15 $74.80 $26.76 $48.04 $109.80 $26.76 $83.04 $118.80 $26.76 $92.04 16 $74.80 $28.54 $46.26 $109.80 $28.54 $81.26 $118.80 $28.54 $90.26 17 $74.80 $30.33 $44.47 $109.80 $30.33 $79.47 $118.80 $30.33 $88.47 18 $74.80 $32.11 $42.69 $109.80 $32.11 $77.69 $118.80 $32.11 $86.69 19 $74.80 $33.90 $40.90 $109.80 $33.90 $75.90 $118.80 $33.90 $84.90 20 $74.80 $35.68 $39.12 $109.80 $35.68 $74.12 $118.80 $35.68 $83.12 21 $74.80 $37.46 $37.34 $109.80 $37.46 $72.34 $118.80 $37.46 $81.34 22 $74.80 $39.25 $35.55 $109.80 $39.25 $70.55 $118.80 $39.25 $79.55 23 $74.80 $41.03 $33.77 $109.80 $41.03 $68.77 $118.80 $41.03 $77.77 24 $74.80 $42.82 $31.98 $109.80 $42.82 $66.98 $118.80 $42.82 $75.98 25 + $74.80 $44.60 $30.20 $109.80 $44.60 $65.20 $118.80 $44.60 $74.20 Anthem Blue Cross - HMO Dental Monthly Premium Rates, Subsidy and Member Costs Single 2-Party Family Years of Service Member Rate Subsidy Member Cost Member Rate Subsidy Member Cost Member Rate Subsidy Member Cost < 10 $30.66 $0.00 $30.66 $62.49 $0.00 $62.49 $95.38 $0.00 $95.38 10 $30.66 $17.84 $12.82 $62.49 $17.84 $44.65 $95.38 $17.84 $77.54 11 $30.66 $19.62 $11.04 $62.49 $19.62 $42.87 $95.38 $19.62 $75.76 12 $30.66 $21.41 $9.25 $62.49 $21.41 $41.08 $95.38 $21.41 $73.97 13 $30.66 $23.19 $7.47 $62.49 $23.19 $39.30 $95.38 $23.19 $72.19 14 $30.66 $24.98 $5.68 $62.49 $24.98 $37.51 $95.38 $24.98 $70.40 15 $30.66 $26.76 $3.90 $62.49 $26.76 $35.73 $95.38 $26.76 $68.62 16 $30.66 $28.54 $2.12 $62.49 $28.54 $33.95 $95.38 $28.54 $66.84 17+ $30.66 $30.33 $0.33 $62.49 $30.33 $32.16 $95.38 $30.33 $65.05