Sheet Metal #10 Benefit Fund MONTHLY Retiree Rates        
Effective May 1, 2016         
                     
                     
    Pre-Medicare Medical   Medicare Medical   Medical      1 + 1   Delta Dental Medical & Dental  
                     
Pre-Medicare                  
  Single $   588.00   n/a       $  38.00 $   626.00  
  Couple  $1,176.00   n/a       $  76.00 $1,252.00  
  Family* $1,506.00   n/a       $118.00 $1,624.00  
                   
Medicare                  
  SMW+ Pensioner                  
  Single     $179.00       $ 38.00 $217.00  
  Couple      $358.00       $ 76.00 $434.00  
  1+1 (1 Pre-medicare and 1 medicare)         $767.00   $ 76.00 $843.00  
                     
  Humana MAPDP Pensioner                  
  Single     $135.00       $ 38.00 $173.00  
  Couple      $270.00       $ 76.00 $346.00  
  1+1 (1 Pre-medicare and 1 medicare)         $723.00   $ 76.00 $799.00  
                     
  UCare Pensioner High Rx Option                  
  Single      $139.00       $ 38.00 $177.00  
  Couple      $278.00       $ 76.00 $354.00  
  1+1 (1 Pre-medicare and 1 medicare)         $727.00   $ 76.00 $803.00  
                     
                     
  UCare Pensioner Core Rx Option                  
  Single      $ 20.00       $ 38.00 $  58.00  
  Couple      $ 40.00       $ 76.00 $116.00  
  1+1 (1 Pre-medicare and 1 medicare)         $608.00   $ 76.00 $684.00  
                     
                     
*Family rate includes $330 for dependent children         
**No National Pension is a participant who is not eligible for the $31.00 Subsidy provided by the National Pension
***1+1 is a couple where one participant is eligible for Medicare and one is pre-Medicare