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2009 Post-65 Retiree Medical Rates
Defined Dollar Benefit Program

Regardless of the medical plan chosen, you are responsible for the Medicare Part B premium. This is a monthly deduction from your Social Security check. The standard Medicare premium for calendar year 2009, although under review by Congress, is published as $96.40. However, according to new rules for higher incomes, the income-related premium will apply to some retirees. The insurance premium rates listed below are for retirees who choose to participate in a University-sponsored plan. All rates listed below are for individual coverage only. The full cost of the dental and vision programs is the responsibility of the retiree. Listed below is a schedule of the insurance premiums for 2009.

University Costs and Retiree Premiums(if applicable) "Old Plan" WITHOUT DDB Participation

University-Sponsored Medical Options Total Premium University Contribution Retiree Responsibility
UPMC for Life HMO $155.00 $155.00 $0
UPMC for Life PPO $184.00 $184.00 $0
Highmark Freedom Blue PPO $197.00 $197.00 $0
UPMC National Complementary Plan $340.00 $221.00 $119.00
Highmark Signature 65 $373.48 $242.76 $130.72

University Costs and Retiree Premiums(if applicable) "New Plan" WITH DDB Participation

University-Sponsored Medical Options Total Premium University-Provided DDB Credit Retiree Responsibility
UPMC for Life HMO $155.00 $290.00 $0 (accrue $135.00)
UPMC for Life PPO $184.00 $290.00 $0 (accrue $106.00)
Highmark Freedom Blue PPO $197.00 $290.00 $0 (accrue $93.00)
UPMC National Complementary Plan $340.00 $290.00 $50.00
Highmark Signature 65 $373.48 $290.00 $83.48

Dental and Vision Plans

Options for Dental and Vision** Total Premium Retiree Responsibility Six-Month Premium
UCCI Concordia Access Dental $16.63 $16.63 $99.78
Davis Vision Fashion Plan $6.84 $6.84 $41.04

Note: ** Enrollment in the Concordia Access Dental plan and Davis Vision plan are for a full 12 month period.

If enrollment is cancelled at any time during the 12-month period for any reason other than death, the annual premium amount is still owed to the carrier.

Benefits Department · 200B Craig Hall · Pittsburgh, PA  15260 · 412-624-8160