2017 Retiree Flight Attendant Insurance Rates Pre-Merger United (hired 8/12/16 and before) retired July August 30, 2016
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1 2017 Retiree Flight Attendant Insurance Rates Pre-Merger United (hired 8/12/16 and before) retired July August 30, 2016 Pre-Medicare retired with 25 or more years of Service Retiree pays 40% contribution + Traditional Medical PPO $ $ $ $ $ $ $ Aetna Intl Traditional PPO $ $ $ $ $ $ $ Core PPO $ $ $ $ $ $ $ Aetna Intl Core PPO $ $ $ $ $ $ $ Core EPO $ $ $ $ $ $ $ Core HDHP $ $ $ $ $ $ $ PPO 350 $ $ $ $ $ $ $ PPO 750 $ $ $ $ $ $ $ PPO 1250 $ $ $ $ $ $ $ Healthy Rewards PPO $ $ $ $ $ $ $ Bronze EPO $18.85 $18.85 $ $0.00 $0.00 $56.55 $18.85 EPO-$0,90%,$25,Rx A $ $ $ $ $ $ $ EPO-$0,90%,$30,Rx A $ $ $ $ $ $ $ EPO-$0,80%,$25,Rx A $ $ $ $ $ $ $ EPO-$0,80%,$30,Rx A $ $ $ $ $ $ $ EPO-$500,90%,$25,Rx A $ $ $ $ $ $ $ EPO-$500,90%,$30,Rx A $ $ $ $ $ $ $ EPO-$500,80%,$25,Rx A $ $ $ $ $ $ $ EPO-$500,80%,$30,Rx A $ $ $ $ $ $ $ EPO-$1000,90%,$25,Rx A $ $ $ $ $ $ $ EPO-$1000,90%,$30,Rx A $ $ $ $ $ $ $ EPO-$1000,80%,$25,Rx A $ $ $ $ $ $ $ EPO-$1000,80%,$30,Rx A $ $ $ $ $ $ $ EPO-$0,90%,$25,Rx B $ $ $ $ $ $ $ EPO-$0,90%,$30,Rx B $ $ $ $ $ $ $ EPO-$0,80%,$25,Rx B $ $ $ $ $ $ $ EPO-$0,80%,$30,Rx B $ $ $ $ $ $ $ EPO-$500,90%,$25,Rx B $ $ $ $ $ $ $ EPO-$500,90%,$30,Rx B $ $ $ $ $ $ $ EPO-$500,80%,$25,Rx B $ $ $ $ $ $ $ EPO-$500,80%,$30,Rx B $ $ $ $ $ $ $ EPO-$1000,90%,$25,Rx B $ $ $ $ $ $ $ EPO-$1000,90%,$30,Rx B $ $ $ $ $ $ $ EPO-$1000,80%,$25,Rx B $97.58 $97.58 $ $ $ $ $97.58 EPO-$1000,80%,$30,Rx B $89.00 $89.00 $ $85.15 $85.15 $ $89.00 Aetna Select AZ $ $ $ $ $ $ $ Aetna Select FL $ $ $ $ $ $ $ Aetna Select MA $ $ $ $ $ $ $
2 Aetna Select MN $ $ $ $ $ $1, $ Aetna Select NC $ $ $ $ $ $1, $ Aetna Select NJ $ $ $ $ $ $ $ Aetna Select NV $ $ $ $ $ $ $ Aetna Select NY $ $ $ $ $ $ $ Aetna Select PA $ $ $ $ $ $ $ Aetna Select Mid-Atlantic $ $ $ $ $ $ $ Aetna Select N CA $ $ $ $ $ $ $ Aetna Select S CA $ $ $ $ $ $ $ Aetna Select Buffalo $ $ $ $ $ $ $ Aetna Select Detroit $ $ $ $ $ $ $ Anthem CO HMO $ $ $ $ $ $ $ BCBS IL HMO $73.60 $73.60 $ $ $ $ $73.60 NetCare Guam Health Plan Plus $ $ $ $ $ $ $ NetCare Guam Health Plan Plus $ $ $ $ $ $ $ NetCare HMO $ $ $ $ $ $ $ NetCare PPO $ $ $ $ $ $ $ NetCare Guam HMO $ $ $ $ $ $ $ NetCare Guam PPO $ $ $ $ $ $ $ NetCare Islands PPO $ $ $ $ $ $ $ NetCare Saipan HMO $ $ $ $ $ $ $ NetCare Saipan PPO $ $ $ $ $ $ $ HMSA HI HMO - sua $ $ $ $ $ $ $ Kaiser N CA HMO - sua $88.59 $88.59 $ $ $ $ $88.59 Kaiser S CA HMO - sua $15.92 $15.92 $33.46 $30.05 $30.05 $47.57 $15.92 Kaiser Denver HMO - sua $ $ $ $ $ $ $ Kaiser HI HMO $ $ $ $ $ $ $ Kaiser Northwest HMO $76.31 $76.31 $ $ $ $ $76.31 Kaiser Mid-Atlantic HMO $72.83 $72.83 $ $ $ $ $72.83 Group Health WA HMO $ $ $ $ $ $ $ Kaiser Atlanta HMO $ $ $ $ $ $ $ Medical Mutual OH HMO $ $ $ $ $ $ $ HMSA HI HMO - sco $ $ $ $ $ $ $ HMSA HI HMO $ $ $ $ $ $ $ HMSA HI PPP - sco $ $ $ $ $ $ $ HMSA HI PPP $ $ $ $ $ $ $ Kaiser N CA HMO - sco $ $ $ $ $ $ $ Kaiser S CA HMO - sco $59.36 $59.36 $ $ $ $ $59.36 Medical Mutual OH POS $ $ $ $ $ $ $ Kaiser Denver HMO - sco $ $ $ $ $ $ $ Kaiser HI POS $ $ $ $ $ $ $ TRICARE Supplemental Plan $60.50 $60.50 $ $ $ $ $60.50 TRICARE Supplemental Plan $44.17 $44.17 $86.17 $86.17 $86.17 $ $44.17 Triple-S $ $ $ $ $ $ $ Aetna International Indemnity $ $ $ $ $ $1, $
3 Pre-Medicare retired with 20 to 24 years of Service Retiree pays 60% contribution + Traditional Medical PPO $ $ $ $ $ $1, $ Aetna Intl Traditional PPO $ $ $ $ $ $1, $ Core PPO $ $ $ $ $ $ $ Aetna Intl Core PPO $ $ $ $ $ $ $ Core EPO $ $ $ $ $ $ $ Core HDHP $ $ $ $ $ $ $ PPO 350 $ $ $ $ $ $ $ PPO 750 $ $ $ $ $ $ $ PPO 1250 $ $ $ $ $ $ $ Healthy Rewards PPO $ $ $ $ $ $1, $ Bronze EPO $ $ $ $ $ $ $ EPO-$0,90%,$25,Rx A $ $ $ $ $ $1, $ EPO-$0,90%,$30,Rx A $ $ $ $ $ $1, $ EPO-$0,80%,$25,Rx A $ $ $ $ $ $ $ EPO-$0,80%,$30,Rx A $ $ $ $ $ $ $ EPO-$500,90%,$25,Rx A $ $ $ $ $ $ $ EPO-$500,90%,$30,Rx A $ $ $ $ $ $ $ EPO-$500,80%,$25,Rx A $ $ $ $ $ $ $ EPO-$500,80%,$30,Rx A $ $ $ $ $ $ $ EPO-$1000,90%,$25,Rx A $ $ $ $ $ $ $ EPO-$1000,90%,$30,Rx A $ $ $ $ $ $ $ EPO-$1000,80%,$25,Rx A $ $ $ $ $ $ $ EPO-$1000,80%,$30,Rx A $ $ $ $ $ $ $ EPO-$0,90%,$25,Rx B $ $ $ $ $ $1, $ EPO-$0,90%,$30,Rx B $ $ $ $ $ $ $ EPO-$0,80%,$25,Rx B $ $ $ $ $ $ $ EPO-$0,80%,$30,Rx B $ $ $ $ $ $ $ EPO-$500,90%,$25,Rx B $ $ $ $ $ $ $ EPO-$500,90%,$30,Rx B $ $ $ $ $ $ $ EPO-$500,80%,$25,Rx B $ $ $ $ $ $ $ EPO-$500,80%,$30,Rx B $ $ $ $ $ $ $ EPO-$1000,90%,$25,Rx B $ $ $ $ $ $ $ EPO-$1000,90%,$30,Rx B $ $ $ $ $ $ $ EPO-$1000,80%,$25,Rx B $ $ $ $ $ $ $ EPO-$1000,80%,$30,Rx B $ $ $ $ $ $ $ Aetna Select AZ $ $ $ $ $ $ $ Aetna Select FL $ $ $ $ $ $ $ Aetna Select MA $ $ $ $ $ $ $ Aetna Select MN $ $ $1, $1, $1, $1, $ Aetna Select NC $ $ $1, $ $ $1, $ Aetna Select NJ $ $ $ $ $ $ $ Aetna Select NV $ $ $ $ $ $ $
4 Aetna Select NY $ $ $ $ $ $ $ Aetna Select PA $ $ $ $ $ $ $ Aetna Select Mid-Atlantic $ $ $ $ $ $ $ Aetna Select N CA $ $ $ $ $ $1, $ Aetna Select S CA $ $ $ $ $ $1, $ Aetna Select Buffalo $ $ $ $ $ $ $ Aetna Select Detroit $ $ $ $ $ $1, $ Anthem CO HMO $ $ $ $ $ $1, $ BCBS IL HMO $ $ $ $ $ $ $ NetCare Guam Health Plan Plus $ $ $ $ $ $1, $ NetCare Guam Health Plan Plus $ $ $ $ $ $1, $ NetCare HMO $ $ $ $ $ $1, $ NetCare PPO $ $ $ $ $ $1, $ NetCare Guam HMO $ $ $ $ $ $ $ NetCare Guam PPO $ $ $ $ $ $1, $ NetCare Islands PPO $ $ $ $ $ $1, $ NetCare Saipan HMO $ $ $ $ $ $ $ NetCare Saipan PPO $ $ $ $ $ $1, $ HMSA HI HMO - sua $ $ $ $ $ $ $ Kaiser N CA HMO - sua $ $ $ $ $ $ $ Kaiser S CA HMO - sua $ $ $ $ $ $ $ Kaiser Denver HMO - sua $ $ $ $ $ $ $ Kaiser HI HMO $ $ $ $ $ $ $ Kaiser Northwest HMO $ $ $ $ $ $ $ Kaiser Mid-Atlantic HMO $ $ $ $ $ $ $ Group Health WA HMO $ $ $ $ $ $1, $ Kaiser Atlanta HMO $ $ $ $ $ $ $ Medical Mutual OH HMO $ $ $ $ $ $ $ HMSA HI HMO - sco $ $ $ $ $ $ $ HMSA HI HMO $ $ $ $ $ $ $ HMSA HI PPP - sco $ $ $ $ $ $ $ HMSA HI PPP $ $ $ $ $ $ $ Kaiser N CA HMO - sco $ $ $ $ $ $ $ Kaiser S CA HMO - sco $ $ $ $ $ $ $ Medical Mutual OH POS $ $ $ $ $ $1, $ Kaiser Denver HMO - sco $ $ $ $ $ $ $ Kaiser HI POS $ $ $ $ $ $1, $ TRICARE Supplemental Plan $60.50 $60.50 $ $ $ $ $60.50 TRICARE Supplemental Plan $44.17 $44.17 $86.17 $86.17 $86.17 $ $44.17 Triple-S $ $ $ $ $ $ $ Aetna International Indemnity $ $ $1, $ $ $1, $
5 Pre-Medicare retired with less than 20 years of Service Retiree pays 80% contribution + Traditional Medical PPO $ $ $1, $1, $1, $1, $ Aetna Intl Traditional PPO $ $ $1, $1, $1, $1, $ Core PPO $ $ $1, $ $ $1, $ Aetna Intl Core PPO $ $ $1, $ $ $1, $ Core EPO $ $ $1, $ $ $1, $ Core HDHP $ $ $1, $ $ $1, $ PPO 350 $ $ $1, $ $ $1, $ PPO 750 $ $ $1, $ $ $1, $ PPO 1250 $ $ $1, $ $ $1, $ Healthy Rewards PPO $ $ $1, $ $ $1, $ Bronze EPO $ $ $ $ $ $ $ EPO-$0,90%,$25,Rx A $ $ $1, $ $ $1, $ EPO-$0,90%,$30,Rx A $ $ $1, $ $ $1, $ EPO-$0,80%,$25,Rx A $ $ $1, $ $ $1, $ EPO-$0,80%,$30,Rx A $ $ $1, $ $ $1, $ EPO-$500,90%,$25,Rx A $ $ $1, $ $ $1, $ EPO-$500,90%,$30,Rx A $ $ $1, $ $ $1, $ EPO-$500,80%,$25,Rx A $ $ $1, $ $ $1, $ EPO-$500,80%,$30,Rx A $ $ $1, $ $ $1, $ EPO-$1000,90%,$25,Rx A $ $ $1, $ $ $1, $ EPO-$1000,90%,$30,Rx A $ $ $1, $ $ $1, $ EPO-$1000,80%,$25,Rx A $ $ $ $ $ $1, $ EPO-$1000,80%,$30,Rx A $ $ $ $ $ $1, $ EPO-$0,90%,$25,Rx B $ $ $1, $ $ $1, $ EPO-$0,90%,$30,Rx B $ $ $1, $ $ $1, $ EPO-$0,80%,$25,Rx B $ $ $1, $ $ $1, $ EPO-$0,80%,$30,Rx B $ $ $1, $ $ $1, $ EPO-$500,90%,$25,Rx B $ $ $1, $ $ $1, $ EPO-$500,90%,$30,Rx B $ $ $1, $ $ $1, $ EPO-$500,80%,$25,Rx B $ $ $1, $ $ $1, $ EPO-$500,80%,$30,Rx B $ $ $ $ $ $1, $ EPO-$1000,90%,$25,Rx B $ $ $ $ $ $1, $ EPO-$1000,90%,$30,Rx B $ $ $ $ $ $1, $ EPO-$1000,80%,$25,Rx B $ $ $ $ $ $1, $ EPO-$1000,80%,$30,Rx B $ $ $ $ $ $1, $ Aetna Select AZ $ $ $ $ $ $1, $ Aetna Select FL $ $ $ $ $ $1, $ Aetna Select MA $ $ $ $ $ $1, $ Aetna Select MN $ $ $1, $1, $1, $2, $ Aetna Select NC $ $ $1, $1, $1, $1, $ Aetna Select NJ $ $ $1, $ $ $1, $
6 Aetna Select NV $ $ $1, $ $ $1, $ Aetna Select NY $ $ $1, $ $ $1, $ Aetna Select PA $ $ $1, $ $ $1, $ Aetna Select Mid-Atlantic $ $ $ $ $ $1, $ Aetna Select N CA $ $ $1, $1, $1, $1, $ Aetna Select S CA $ $ $1, $1, $1, $1, $ Aetna Select Buffalo $ $ $1, $ $ $1, $ Aetna Select Detroit $ $ $1, $ $ $1, $ Anthem CO HMO $ $ $1, $1, $1, $1, $ BCBS IL HMO $ $ $ $ $ $1, $ NetCare Guam Health Plan Plus $ $ $1, $ $ $1, $ NetCare Guam Health Plan Plus $ $ $1, $ $ $1, $ NetCare HMO $ $ $1, $ $ $1, $ NetCare PPO $ $ $1, $ $ $1, $ NetCare Guam HMO $ $ $1, $ $ $1, $ NetCare Guam PPO $ $ $1, $ $ $1, $ NetCare Islands PPO $ $ $1, $ $ $1, $ NetCare Saipan HMO $ $ $1, $ $ $1, $ NetCare Saipan PPO $ $ $1, $ $ $1, $ HMSA HI HMO - sua $ $ $ $ $ $1, $ Kaiser N CA HMO - sua $ $ $ $ $ $1, $ Kaiser S CA HMO - sua $ $ $ $ $ $ $ Kaiser Denver HMO - sua $ $ $ $ $ $1, $ Kaiser HI HMO $ $ $ $ $ $1, $ Kaiser Northwest HMO $ $ $ $ $ $1, $ Kaiser Mid-Atlantic HMO $ $ $ $ $ $1, $ Group Health WA HMO $ $ $1, $ $ $1, $ Kaiser Atlanta HMO $ $ $ $ $ $1, $ Medical Mutual OH HMO $ $ $1, $ $ $1, $ HMSA HI HMO - sco $ $ $ $ $ $1, $ HMSA HI HMO $ $ $ $ $ $1, $ HMSA HI PPP - sco $ $ $ $ $ $1, $ HMSA HI PPP $ $ $ $ $ $1, $ Kaiser N CA HMO - sco $ $ $ $ $ $1, $ Kaiser S CA HMO - sco $ $ $ $ $ $1, $ Medical Mutual OH POS $ $ $1, $ $ $1, $ Kaiser Denver HMO - sco $ $ $1, $ $ $1, $ Kaiser HI POS $ $ $1, $1, $1, $1, $ TRICARE Supplemental Plan $60.50 $60.50 $ $ $ $ $60.50 TRICARE Supplemental Plan $44.17 $44.17 $86.17 $86.17 $86.17 $ $44.17 Triple-S $ $ $1, $ $ $1, $ Aetna International Indemnity $ $ $1, $1, $1, $2, $
7 Post-Medicare Retiree Post-Medicare plans are predicated on the retiree taking Medicare parts A and B. Retiree cost includes United $90 per month contribution + Aetna International Medicare $ $ $ $ $ $ $ Aetna Medicare Select $ $ $ $ $ $ $ Aetna Retiree Medical $ $ $ $ $ $ $ Group Health WA HMO $ $ $ $ $ $ $ HealthNet CA HMO $ $ $ $ $ $ $ Humana IL HMO $ $ $ $ $ $ $ Kaiser CO HMO $ $ $ $ $ $ $ Kaiser GA $ $ $ $ $ $ $ Kaiser HI HMO $ $ $ $ $ $ $ Kaiser Mid-Atlantic $ $ $ $ $ $ $ Kaiser N CA HMO $ $ $ $ $ $ $ Kaiser Northwest HMO $ $ $ $ $ $ $ Kaiser S CA HMO $70.80 $70.80 $ $ $ $ $70.80 Rx $ $ $ $ $ $ $ UnitedHealthcare AZ HMO $ $ $ $ $ $ $ UnitedHealthcare CA HMO $ $ $ $ $ $ $ UnitedHealthcare CO HMO $ $ $ $ $ $ $ UnitedHealthcare NV HMO $49.18 $49.18 $98.36 $98.36 $98.36 $ $49.18 Retiree Vision Total Rates Retiree VSP Plan $16.46 $28.11 $28.68 $36.36 For information on plan designs (covered services and cost of services) please access Flying Together, Employee Service, YBR (r Benefits Resources). Rates in these chart are subject AFA actuarial review. 7
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