Hawaii Employer-Union Health Benefits Trust Fund EUTF Monthly Active COBRA Rates (All except BU12)
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1 EUTF Monthly Active Rates (All except BU12) Supplemental - Royal State Nat ional Supplemental Prescription Drug PPO - 90/10 Plan - HMSA Medical PPO - 80/20 Plan - HMSA Medical PPO - 75/25 Plan - HMSA Medical EUTF PPO Prescription Drug - CVS Caremark HMO - HMSA Medical EUTF HMO Prescription Drug - CVS Caremark HMO - Kaiser Co mprehensive Medical HMO - Kaiser Standard Medical Self $ $ Two Party 1, , Family 1, , Self $ $ Two-Party , Family 1, , Self $ $ Two-Party , Family 1, , Self $ $ Two-Party Family Self $ $ Two-Party 1, , Family 1, , Self $ $ Two-Party Family Self $ $ Two-Party 1, , Family 1, , Self $ $ Two-Party , Family 1, , Self $ $ Two-Party Family
2 EUTF Monthly Active Rates - Bargaining Unit 12 Supplemental - Royal State National Supplemental Prescription Drug PPO - 90/10 Plan - HMSA Medical PPO - 80/20 Plan - HMSA Medical PPO - 75/25 Plan - HMSA Medical EUTF PPO Prescription Drug - CVS Caremark HMO - HMSA Medical EUTF HMO Prescription Drug - CVS Caremark HMO - Kaiser Comprehensive Medical HMO - Kaiser Standard Medical Self $ $ Two Party , Family 1, , Self $ $ Two-Party , Family 1, , Self $ $ Two-Party , Family , Self $ $ Two-Party Family Self $ $ Two-Party , Family 1, , Self $ $ Two-Party Family Self $ $ Two-Party 1, , Family 1, , Self $ $ Two-Party , Family , Self $ $ Two-Party Family
3 HSTA VB Monthly Active Rates S HSTA VB - HSTA VB - PPO - 90/10 Plan - HMSA Medical HSTA VB - PPO - 80/20 Plan - HMSA Medical HSTA VB PPO Prescription Drug - CVS Caremark HSTA VB - HMO - Kaiser Comprehensive Medical HSTA VB - HSTA VB - HDS Supplemental Dental Self $ $ Two Party 1, , Family 1, , Self $ $ Two-Party , Family , Self $ $ Two-Party Family Self $ $ Two-Party 1, , Family 1, , Self $ $ Two-Party Family
4 EUTF Monthly Retiree Rates 1/1/ /31/ MEDICARE HMSA PPO Medicare Medicare Prescription Drug Kaiser HMO Medicare - NON-MEDICARE HMSA PPO Non-Medicare Non-Medicare Prescription Drug Kaiser HMO Non Medicare Self $ Two Party Family Self $ Two-Party Family Self $ Two-Party Family 1, Self $ Two-Party Family 1, Self $ Two-Party Family Self $ Two-Party 1, Family 1, Self $ Two-Party Family Self $ 5.43 Two-Party Family
5 HSTA VB Monthly Retiree Rates 1/1/ /31/ MEDICARE HMSA PPO Medicare Medicare Prescription Drug Kaiser HMO Medicare - NON-MEDICARE HMSA PPO Non-Medicare Non-Medicare Prescription Drug Kaiser HMO Non Medicare Self $ Two Party Family Self $ Two-Party Family Self $ Two-Party Family 1, Self $ Two-Party Family 1, Self $ Two-Party Family Self $ Two-Party 1, Family 1, Self $ Two-Party Family Self $ 5.43 Two-Party Family Self $ 1.46 Two-Party 2.93 Family
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