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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
$17.30
$57.50
$109.80
$17.30
$92.50
$118.80
$17.30
$101.50
11
$74.80
$19.03
$55.77
$109.80
$19.03
$90.77
$118.80
$19.03
$99.77
12
$74.80
$20.76
$54.04
$109.80
$20.76
$89.04
$118.80
$20.76
$98.04
13
$74.80
$22.48
$52.32
$109.80
$22.48
$87.32
$118.80
$22.48
$96.32
14
$74.80
$24.21
$50.59
$109.80
$24.21
$85.59
$118.80
$24.21
$94.59
15
$74.80
$25.94
$48.86
$109.80
$25.94
$83.86
$118.80
$25.94
$92.86
16
$74.80
$27.67
$47.13
$109.80
$27.67
$82.13
$118.80
$27.67
$91.13
17
$74.80
$29.40
$45.40
$109.80
$29.40
$80.40
$118.80
$29.40
$89.40
18
$74.80
$31.13
$43.67
$109.80
$31.13
$78.67
$118.80
$31.13
$87.67
19
$74.80
$32.86
$41.94
$109.80
$32.86
$76.94
$118.80
$32.86
$85.94
20
$74.80
$34.59
$40.21
$109.80
$34.59
$75.21
$118.80
$34.59
$84.21
21
$74.80
$36.32
$38.48
$109.80
$36.32
$73.48
$118.80
$36.32
$82.48
22
$74.80
$38.05
$36.75
$109.80
$38.05
$71.75
$118.80
$38.05
$80.75
23
$74.80
$39.78
$35.02
$109.80
$39.78
$70.02
$118.80
$39.78
$79.02
24
$74.80
$41.51
$33.29
$109.80
$41.51
$68.29
$118.80
$41.51
$77.29
25 +
$74.80
$43.24
$31.56
$109.80
$43.24
$66.56
$118.80
$43.24
$75.56
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 $17.30 $13.36 $62.49 $17.30 $45.19 $95.38 $17.30 $78.08
11
$30.66 $19.03 $11.63 $62.49 $19.03 $43.46 $95.38 $19.03 $76.35
12
$30.66 $20.76
$9.90 $62.49 $20.76 $41.73 $95.38 $20.76 $74.62
13
$30.66 $22.48
$8.18 $62.49 $22.48 $40.01 $95.38 $22.48 $72.90
14
$30.66 $24.21
$6.45 $62.49 $24.21 $38.28 $95.38 $24.21 $71.17
15
$30.66 $25.94
$4.72 $62.49 $25.94 $36.55 $95.38 $25.94 $69.44
16
$30.66 $27.67
$2.99 $62.49 $27.67 $34.82 $95.38 $27.67 $67.71
17+
$30.66 $29.40
$1.26 $62.49 $29.40 $33.09 $95.38 $29.40 $65.98