IRS Form W-2

Listed below are the 2019 monthly premiums for State Health Benefit Plan (SHBP) coverage. This is the cost of group health coverage provided to your employees covered by SHBP on Internal Revenue Service Form W-2 in January 2020. Please remember to add $80.00 for your employees who are subject to the tobacco surcharge and enrolled in Anthem BlueCross and BlueShield (Anthem), UnitedHealthcare and Kaiser Permanente (KP) plan options.

2019 Monthly Premiums

  You You + Child(ren) You + Spouse You + Family
Anthem Gold $696.99 $1,184.89 $1,463.69 $1,951.58
Anthem Silver $638.46 $1,085.38 $1,340.76 $1,787.69
Anthem Bronze $599.99 $1,019.97 $1,259.97 $1,679.96
Anthem HMO $664.30 $1,129.30 $1,395.02 $1,860.03
UnitedHealthcare HMO $700.05 $1,190.08 $1,470.10 $1,960.13
UnitedHealthcare HDHP $583.68 $992.26 $1,225.73 $1,634.30
KP HMO $589.34 $1,001.89 $1,237.62 $1,650.17
 

 

2019 TRICARE Supplement Monthly Premiums

You You + Child(ren) You + Spouse You + Family
$60.50 $119.50 $119.50  $160.50

Click here for 2018 IRS Form W-2 for 2018 Reporting