Dental plan premiums You must enroll in medical coverage to enroll in dental. Managed Care Plans Preferred Provider Organization (PPO) DeltaCare Willamette Dental Group Uniform Dental Plan Monthly premiums Subscriber only $41.50 $48.87 $48.92 Subscriber & spouse $83.00 $97.74 $97.84 Subscriber & children $83.00 $97.74 $97.84 Subscriber, spouse, $124.50 $146.61 $146.76 & children Retiree term life insurance premiums The table below shows that monthly costs increase as your age increases, but your bene昀椀t coverage amount does not change. Administered by Metropolitan Life Insurance Company. Your age 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85–89 90–94 95+ Monthly cost for... $5,000 $0.87 $1.34 $2.50 $3.84 $7.38 $11.97 $19.41 $31.43 $50.90 $82.45 $133.57 coverage $10,000 $1.74 $2.67 $5.00 $7.67 $14.76 $23.94 $38.81 $62.86 $101.79 $164.89 $267.14 coverage $15,000 $2.61 $4.01 $7.50 $11.51 $22.14 $35.91 $58.22 $94.29 $152.69 $247.34 $400.71 coverage $20,000 $3.48 $5.34 $10.00 $15.34 $29.52 $47.88 $77.62 $125.72 $203.58 $329.78 $534.28 coverage Legacy retiree life insurance plan premiums The legacy retiree life insurance plan is only available to retirees enrolled as of December 31, 2016, who didn’t elect to increase their retiree term life insurance amount during MetLife’s open enrollment (November 1–30, 2016). Administered by Metropolitan Life Insurance Company. Age at death Amount of insurance Monthly cost Under 65 $3,000 $7.75 65 through 69 $2,100 $7.75 70 and over $1,800 $7.75 HCA is committed to providing equal access to our services. If you need an accommodation or require documents in another format, please call us at 1-800-200-1004 (TRS: 711). 4