Plan Year:
Select Your Plan and Coverage Level
Plans:
Coverage Levels:
Select Your Plan and Coverage Level
Plans:
Coverage Levels:

Select Your Plan and Coverage Level

Plans:
Coverage Levels:

Select Tobacco User(s)

You must certify yourself and your dependent(s) as tobacco users or non-users. You will pay a Tobacco User Premium of $30 per month for each person in your household who uses tobacco or fails to certify (up to a household maximum of $90 per month).

Tobacco Users

Select all applicable covered individuals who use tobacco or are not certified.

Optional Life and Dependent Life

*This calculator only applies if you are an employee and under age 70.
If you are over age 69 or retired, please contact ERS.
$
/
Voluntary AD & D
*Enter between $10,000 and $200,000 in $5,000 increments. Amounts decrease after age 70.
$
Disability
$

Medical Premiums

Description Individuals Covered State Pays You Pay

Dental Premiums

Description Individuals Covered State Pays You Pay

Vision Premiums

Description Individuals Covered State Pays You Pay

Optional and Dependent Life Premiums

Description Individuals Covered Coverage Amount You Pay

Voluntary AD & D Premiums

Individuals Covered Coverage Amount You Pay

Disability Premiums

Description Individuals Covered You Pay