DPRS21
State of Maryland Department of
Budget & Management
DIRECT PAY ENROLLEES
Eective 01/01/2022 thru 12/31/2022
Monthly Rates
PPO HEALTH PLANS
Plan Type CareFirst BC/BS UnitedHealthcare Options
Individual $559.58 $550.44
Individual + one person $1,007.20 $990.82
Individual + two or more $1,398.94 $1,376.22
FORMS CAN BE FOUND ON OUR WEBSITE AT: www.dbm.maryland.gov/benets
EPO HEALTH PLANS IHM HEALTH PLAN
Plan Type CareFirst BC/BS UnitedHealthcare Select Kaiser Permanente
Individual $497.96 $500.98 $497.64
Individual + one person $1,045.02 $1,041.88 $1,044.34
Individual + two or more $1,294.66 $1,242.28 $1,293.82
PRESCRIPTION DRUG
Plan Type CVS Caremark
Individual $247.90
Individual + Child $329.46
Individual + Spouse $411.42
Individual + two or more $495.80
DENTAL
Plan Type
Delta Dental United Concordia
DHMO DPPO
Individual $16.66 $25.86
Individual + Child $33.38 $49.46
Individual + Spouse $29.06 $51.74
Individual + two or more $46.88 $96.96
ACCIDENTAL DEATH & DISMEMBERMENT
Amount Individual Only Family
$100,000 $1.20 $2.30
$200,000 $2.40 $4.60
$300,000 $3.60 $6.90
IMPORTANT:
COBRA ENROLLEES NEED TO ADD
2% FOR ADMINISTRATIVE FEE.
TERM LIFE INSURANCE PREMIUM RATES
Age of Employee/
Retiree
Employee Retiree Rates
(per $1,000)
Age of
Spouse
Spouse Rates
(per $1,000)
Under 30 $0.03 Under 30 $0.09
30 to 34 $0.04 30 to 34 $0.10
35 to 39 $0.05 35 to 39 $0.12
40 to 44 $0.08 40 to 44 $0.18
45 to 49 $0.13 45 to 49 $0.28
50 to 54 $0.20 50 to 54 $0.42
55 to 59 $0.37 55 to 59 $0.65
60 to 64 $0.52 60 to 64 $1.00
65 to 69 $0.77 65 to 69 $1.45
70 to 74 $1.38 70 to 74 $2.28
75 to 79 $2.06 75 to 79 $2.28
80 and older $2.06 80 and older $2.28
Dependent Child Coverage is $0.14 per $1,000 per month.