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Rates are calculated by the City of Salem Human Resources Department GIC Health Plan Rates RATES AS OF JULY 1, 2024 FOR CITY OF SALEM ENROLLEES Active Employees, Retirees and Survivors Without Medicare ACTIVE EMPLOYEE RETIREE SURVIVOR HEALTH PLAN PLAN TYPE Individual Coverage Family Coverage Individual Coverage Family Coverage Individual Coverage Family Coverage Harvard Pilgrim Explorer POS 320.36 793.77 320.36 793.77 533.94 1322.95 Harvard Pilgrim Access America PPO 377.82 842.78 377.82 842.78 629.70 1404.63 Harvard Pilgrim Quality HMO 197.01 501.45 236.41 601.74 394.02 1002.91 MGB HMO 244.42 646.36 293.30 775.63 488.83 1292.71 Health New England HMO 194.56 466.74 233.48 560.09 389.13 933.48 Wellpoint Total Choice Indemnity 525.47 1166.10 525.47 1166.10 750.68 1665.86 Wellpoint Community Choice PPO-type 223.49 554.73 223.49 554.73 372.49 924.55 Wellpoint PLUS PPO-type 287.59 685.22 287.59 685.22 479.31 1142.03 HMO: Employees pay 25%; Retirees w/out Medicare pay 30% POS & PPO-type: Employees and Retirees w/out Medicare Pay 30% Indemnity: Employees and Retirees w/out Medicare pay 35% All Plans: Survivors pay 50%