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| Monthly Premiums (Medicare Plans with or without Part D, Superior Vision Services and Delta Dental): Member Only | ||||
|---|---|---|---|---|
| Medical Plan (with or without Part D) | Monthly Premium for Medical Plan (with or without Part D) |
Superior Vision Services: Basic Plan |
Superior Vision Services: Enhanced Plan |
Delta Dental |
| Coventry Advantra Freedom PPO with Coventry Part D | $87.50 | $6.54 | $10.89 | $30.64 |
| Coventry Advantra Freedom PPO with SilverScript | $188.50 | $6.54 | $10.89 | $30.64 |
| Humana PPO with Humana Part D | $145.50 | $6.54 | $10.89 | $30.64 |
| Humana PPO with SilverScript | $240.50 | $6.54 | $10.89 | $30.64 |
| Kansas Senior Plan C with SilverScript | $343.31 | $6.54 | $10.89 | $30.64 |
| Kansas Senior Plan C without SilverScript | $188.31 | $6.54 | $10.89 | $30.64 |
Important Reminders:
The premiums provided for vision and dental coverage above are separate from the premiums provided for the medical plans. Therefore, when calculating your total monthly premium, please be sure to add all three premium amounts, as applicable.