Participants and/or their employers wishing to change coverage (among Medical Plan A, B, and C options) for the upcoming Plan Year must do so in writing by November 15 of the current Plan year. Notification should be emailed to info@pbucc.org or sent via fax to Member Services at 212-729-2701.
Rates shown are approximate and are provided for budgetary purposes only.
Your actual rate may vary slightly due to age and location.
If you elect to have coverage, your bill will reflect the exact amount.
| Non-Medicare Rates: | Plan A | Plan B | Plan C |
| Single | |||
| Two Adults | |||
| Single w/Child(ren) | |||
| Two Adults w/Child(ren) |
| UCC Dental Plan: | |
|---|---|
| Single | $ |
| Two Adults | $ |
| Single w/Child(ren) | $ |
| Two Adults w/Child(ren) | $ |
| Annual Vision Rates: | |
|---|---|
| Single | $ |
| Two Adults | $ |
| Single w/Child(ren) | $ |
| Two Adults w/Child(ren) | $ |
| Single | Tier 1 | $51.75 |
| Two Adults | Tier 2 | $99.75 |
| Single w/Child(ren) | Tier 3 | $101.00 |
| Two Adults w/Child(ren) | Tier 4 | $113.50 |
* The correct age rate is based on the employee's age as of January 1 of the current Plan Year.
* If an employee will age into a different age band during the current Plan Year, their rate will not change until January 1 of the following Plan Year.