Exhibit A: Non-Medicare Eligible Retiree Premium Rates
Commonwealth of Virginia Health Benefits Non-Medicare retiree monthly premiums for July 1, 2024-June 30, 2025
Non-Medicare eligible retiree group members pay the total premium.
Please note: Get a premium reward if you are enrolled in COVA Care or COVA HealthAware. You or your spouse can complete certain health activities to pay $17 less a month or $34 less when both of you meet the requirements.
The table below is best viewed at horizontal orientation on your device.
| Health Care Plans | Premium | Premium with Rewards | |||||||
|---|---|---|---|---|---|---|---|---|---|
| YOU only | YOU plus ONE | YOU plus TWO or MORE | YOU only | YOU plus SPOUSE | YOU plus SPOUSE and MORE | ||||
| Employee | Employee or Spouse | Employee & Spouse | Employee or Spouse | Employee & Spouse | |||||
| COVA Care | Total Premium | $886 | $1,640 | $2,379 | $869 | $1,623 | $1,606 | $2,362 | $2,345 |
| COVA Care + Out-of-Nework | Total Premium | $907 | $1,679 | $2,436 | $890 | $1,662 | $1,645 | $2,419 | $2,402 |
| COVA Care + Expanded Dental | Total Premium | $919 | $1,700 | $2,467 | $902 | $1,683 | $1,666 | $2,450 | $2,433 |
| COVA Care + Out-of-Network + Expanded Dental | Total Premium | $940 | $1,739 | $2,524 | $923 | $1,722 | $1,705 | $2,507 | $2,490 |
| COVA Care + Expanded Dental + Hearing & Vision | Total Premium | $939 | $1,737 | $2,521 | $922 | $1,720 | $1,703 | $2,504 | $2,487 |
| COVA Care + out-of-Network + Expanded Dental + VIsion & Hearing | Total Premium | $960 | $1,776 | $2,578 | $943 | $1,759 | $1,742 | $2,561 | $2,544 |
| COVA HealthAware | Total Premium | $785 | $1,457 | $2,110 | $768 | $1,440 | $1,423 | $2,093 | $2,076 |
| COVA HealthAware + Expanded Dental | Total Premium | $818 | $1,517 | $2,198 | $801 | $1,500 | $1,483 | $2,181 | $2,164 |
| COVA HealthAware + Expanded Dental & VIsion | Total Premium | $828 | $1,537 | $2,226 | $811 | $1,520 | $1,503 | $2,209 | $2,192 |
| COVA HDHP | Total Premium | $665 | $1,239 | $1,810 | |||||
| COVA HDHP + Expanded Dental | Total Premium | $698 | $1,299 | $1,898 | |||||
| Kaiser Permanente HMO - (available primarily in Northern Virginia) | Total Premium | $869 | $1,597 | $2,327 | |||||
| Sentara Health Plans HMO (available in Hampton Roads/Eastern Shore | Total Premium | $855 | $1,584 | $2,293 | |||||
| TIRCARE Voluntary Supplement | Total Premium | $61 | $120 | $161 | |||||
Human Resources
