Plan Year 2015
P.O. Box 40187 | Portland, OR 97240-0187
PH: (503) 224-7377 or (800) 768-7377
FAX: (503) 765-3452 or 1-888-393-2943
Effective January 1, 2015 through December 31, 2015
These rates are provided to help you determine what your monthly premium will be. The monthly premiums shown here are after the contribution from the
RHIPA has been applied. If you are eligible for this contribution, the rates shown on this page are what you would pay for your coverage. For more information
on the RHIPA contribution and eligibility, call the PERS Health Insurance Program at 503-224-7377 or 800-768-7377, or access at pershealth.com.
State Retiree without Medicare
Moda
Kaiser
PacificSource
Providence
Core
Select
Core
Select
Core
Select
Core
Select
Rate w/o subsidy
$ 879.34
$ 843.73
$ 734.97
$ 595.85
$ 870.76
$ 771.06
$ 774.46
$ 672.85
8 but less than 10 years
$ 717.64
$ 682.03
$ 573.27
$ 434.15
$ 709.06
$ 609.36
$ 612.76
$ 511.15
10 but less than 15 years
$ 685.30
$ 649.69
$ 540.93
$ 401.81
$ 676.72
$ 577.02
$ 580.42
$ 478.81
15 but less than 20 years
$ 652.96
$ 617.35
$ 508.59
$ 369.47
$ 644.38
$ 544.68
$ 548.08
$ 446.47
20 but less than 25 years
$ 620.62
$ 585.01
$ 476.25
$ 337.13
$ 612.04
$ 512.34
$ 515.74
$ 414.13
25 but less than 30 years
$ 588.28
$ 552.67
$ 443.91
$ 304.79
$ 579.70
$ 480.00
$ 483.40
$ 381.79
30 and more years
$ 555.94
$ 520.33
$ 411.57
$ 272.45
$ 547.36
$ 447.66
$ 451.06
$ 349.45
State Retiree without Medicare; Family* without Medicare
Moda
Kaiser
PacificSource
Providence
Core
Select
Core
Select
Core
Select
Core
Select
Rate w/o subsidy
$ 1,651.21
$ 1,579.99
$ 1,467.94
$ 1,189.70
$ 1,810.85
$ 1,601.48
$ 1,594.77
$ 1,383.42
8 but less than 10 years
$ 1,489.51
$ 1,418.29
$ 1,306.24
$ 1,028.00
$ 1,649.15
$ 1,439.78
$ 1,433.07
$ 1,221.72
10 but less than 15 years
$ 1,457.17
$ 1,385.95
$ 1,273.90
$ 995.66
$ 1,616.81
$ 1,407.44
$ 1,400.73
$ 1,189.38
15 but less than 20 years
$ 1,424.83
$ 1,353.61
$ 1,241.56
$ 963.32
$ 1,584.47
$ 1,375.10
$ 1,368.39
$ 1,157.04
20 but less than 25 years
$ 1,392.49
$ 1,321.27
$1,209.22
$ 930.98
$ 1,552.13
$ 1,342.76
$ 1,336.05
$ 1,124.70
25 but less than 30 years
$ 1,360.15
$ 1,288.93
$ 1,176.88
$ 898.64
$ 1,519.79
$ 1,310.42
$ 1,303.71
$ 1,092.36
30 and more years
$ 1,327.81
$ 1,256.59
$ 1,144.54
$ 866.30
$ 1,487.45
$ 1,278.08
$ 1,271.37
$ 1,060.02
2015 RHIPA Rates Flier.FINAL_1
State Retiree without Medicare; Family* with Medicare
Moda
Kaiser
PacificSource
Core /
Select /
Medicare Medicare
801
801
Core/
Supp
Core /
PPORX
Select /
Supp
Select /
PPORX
Core /
Sr. Adv
Select /
Sr. Adv
Rate w/o subsidy
$1,063.62
$ 1,038.06
$ 1,028.01
$ 1,002.45
$ 954.34
$ 815.22
$ 1,090.01
8 but less than 10 years
$ 901.92
$ 876.36
$ 866.31
$ 840.75
$ 792.64
$ 653.52
10 but less than 15 years
$ 869.58
$ 844.02
$ 833.97
$ 808.41
$ 760.30
15 but less than 20 years
$ 837.24
$ 811.68
$ 801.63
$ 776.07
20 but less than 25 years
$ 804.90
$ 779.34
$ 769.29
25 but less than 30 years
$ 772.56
$ 747.00
30 and more years
$ 740.22
$ 714.66
Providence
Core /
Align
Core /
Flex
Select /
Align
Select /
Flex
$ 990.31
$ 972.61
$ 947.61
$ 871.00
$ 846.00
$ 928.31
$ 828.61
$ 810.91
$ 785.91
$ 709.30
$ 684.30
$ 621.18
$ 895.97
$ 796.27
$ 778.57
$ 753.57
$ 676.96
$ 651.96
$ 727.96
$ 588.84
$ 863.63
$ 763.93
$ 746.23
$ 721.23
$ 644.62
$ 619.62
$ 743.73
$ 695.62
$ 556.50
$ 831.29
$ 731.59
$ 713.89
$ 688.89
$ 612.28
$ 587.28
$ 736.95
$ 711.39
$ 663.28
$ 524.16
$ 798.95
$ 699.25
$ 681.55
$ 656.55
$ 579.94
$ 554.94
$ 704.61
$ 679.05
$ 630.94
$ 491.82
$ 766.61
$ 666.91
$ 649.21
$ 624.21
$ 547.60
$ 522.60
RHIPA (State of Oregon Non-Medicare) Subsidy
The Oregon Legislature established the Retiree Health Insurance Premium Account (RHIPA), which pays a monthly contribution toward the cost for health care coverage for
some state of Oregon retirees who are not eligible for Medicare. The following describes the eligibility requirements for participating in a RHIPA subsidized PERS sponsored
health insurance plan.
1. The retiree is a Tier One or Tier Two eligible retired state employee who is not eligible for Medicare, and
2. Is receiving a PERS service retirement allowance or benefit; or is receiving a PERS disability retirement allowance computed as if the member had eight or more years of
credible state service and has attained the earliest retirement age, and
3. Who was a state employee at the time of retirement, and has a PERS effective retirement date beginning the first of the month following termination of state
employment, and
4. Who has eight or more years of qualifying state service at the time of retirement.
A surviving spouse or dependent of a deceased eligible retired state employee, who is not eligible for Medicare, may be eligible to receive the RHIPA subsidy if the following
requirements are met:
1. Is receiving a retirement allowance or benefit from PERS, or
2. Was covered under a PERS sponsored health insurance plan at the time of the retiree’s death and the eligible retired state employee retired on or after September 29,
1991. If, however, you are a surviving spouse and are no longer eligible for an ongoing pension benefit, you may no longer be eligible for the RHIPA subsidy either.

For the purposes of determining the premium under the PERS Health Insurance Program (PHIP) a “Family” includes an eligible spouse and/or dependents as defined in OAR
459-035-0020. The non-Medicare Family rate will apply in any instance where there is at least one non-Medicare Family member.
Premium payment information:
Because the verification process is based on finalized pension calculations, the retiree could be invoiced the full premium amount until eligibility for the
subsidy is verified. Upon verification, if the retiree is due a refund, it will be calculated and sent automatically.