Rates for Unloaded Industries* Option 2: DE Preventive Care PPO Max 2 to 9 $17.60 $34.60 $34.40 $51.70 10 to 25 $15.80 $31.60 $31.30 $47.30 26 to 50 $15.10 $29.90 $29.70 $44.90 Option 3: DE Preventive Care PPO 2 to 9 $20.90 $41.10 $40.90 $61.50 10 to 25 $19.20 $37.40 $37.10 $56.10 26 to 50 $18.40 $35.70 $35.50 $53.50 Option 4: DE PPO Max 1000 2 to 9 $28.90 $58.10 $56.80 $85.60 10 to 25 $26.60 $53.20 $52.00 $78.10 26 to 50 $25.40 $50.50 $49.40 $74.50 Option 5: DE Active PPO, High Option 2 to 9 $37.40 $75.50 $76.80 $114.80 10 to 25 $34.30 $68.90 $77.40 $112.00 26 to 50 $32.70 $65.50 $73.70 $106.70 * If the group s SIC code does not appear on the list of Loaded Industries or Ineligible Industries, these rates apply. Option 6: DE PPO 1500 2 to 9 $40.90 $82.00 $81.10 $121.70 10 to 25 $37.10 $74.80 $81.80 $119.00 26 to 50 $35.50 $71.20 $77.70 $113.20 Option 7: DE PPO 1500 (90th) 2 to 9 $41.40 $83.10 $82.20 $123.50 10 to 25 $37.70 $75.90 $83.00 $120.70 26 to 50 $35.90 $72.30 $78.90 $114.90
Rates for Unloaded Industries* Voluntary Option 2: DE Preventive Care PPO Max 3 to 9 $19.40 $38.00 $37.60 $56.80 10 to 25 $17.70 $34.80 $34.50 $52.00 26 to 50 $16.60 $33.20 $32.90 $49.40 Voluntary Option 3: DE Preventive Care PPO 3 to 9 $22.90 $45.10 $44.90 $67.70 10 to 25 $21.00 $41.30 $41.10 $61.80 26 to 50 $20.00 $39.40 $39.20 $58.80 Voluntary Option 4: DE PPO Max 1000 3 to 9 $31.30 $62.90 $61.50 $92.50 10 to 25 $28.50 $57.30 $56.10 $84.40 26 to 50 $27.30 $54.80 $53.50 $80.50 * If the group s SIC code does not appear on the list of Loaded Industries or Ineligible Industries, these rates apply.
Rates for Loaded Industries* Option 2: DE Preventive Care PPO Max 2 to 9 $19.40 $38.10 $37.80 $56.90 10 to 25 $17.40 $34.80 $34.40 $52.00 26 to 50 $16.60 $32.90 $32.70 $49.40 Option 3: DE Preventive Care PPO 2 to 9 $23.00 $45.20 $45.00 $67.70 10 to 25 $21.10 $41.10 $40.80 $61.70 26 to 50 $20.20 $39.30 $39.10 $58.90 Option 4: DE PPO Max 1000 2 to 9 $31.80 $63.90 $62.50 $94.20 10 to 25 $29.30 $58.50 $57.20 $85.90 26 to 50 $27.90 $55.60 $54.30 $82.00 Option 5: DE Active PPO, High Option 2 to 9 $41.10 $83.10 $84.50 $126.30 10 to 25 $37.70 $75.80 $85.10 $123.20 26 to 50 $36.00 $72.10 $81.10 $117.40 * If the group s SIC code appears on the list of Loaded Industries, these rates apply. If the group s SIC appears on the list of Ineligible Industries and the group is offering an Aetna medical plan, these rates apply. Option 6: DE PPO 1500 2 to 9 $45.00 $90.20 $89.20 $133.90 10 to 25 $40.80 $82.30 $90.00 $130.90 26 to 50 $39.10 $78.30 $85.50 $124.50 Option 7: DE PPO 1500 (90th) 2 to 9 $45.50 $91.40 $90.40 $135.90 10 to 25 $41.50 $83.50 $91.30 $132.80 26 to 50 $39.50 $79.50 $86.80 $126.40
Rates for Loaded Industries* Voluntary Option 2: DE Preventive Care PPO Max 3 to 9 $21.30 $41.80 $41.40 $62.50 10 to 25 $19.50 $38.30 $38.00 $57.20 26 to 50 $18.30 $36.50 $36.20 $54.30 Voluntary Option 3: DE Preventive Care PPO 3 to 9 $25.20 $49.60 $49.40 $74.50 10 to 25 $23.10 $45.40 $45.20 $68.00 26 to 50 $22.00 $43.30 $43.10 $64.70 Voluntary Option 4: DE PPO Max 1000 3 to 9 $34.40 $69.20 $67.70 $101.80 10 to 25 $31.40 $63.00 $61.70 $92.80 26 to 50 $30.00 $60.30 $58.90 $88.60 * If the group s SIC code appears on the list of Loaded Industries, these rates apply. If the group s SIC appears on the list of Ineligible Industries and the group is offering an Aetna medical plan, these rates apply.
SIC Codes for Ineligible Industries* SIC Range SIC Description 7933 Bowling Centers 8611 Business Associations 7911 Dance Studios, Schools 7361-7363 Employment Agencies 7999 Misc Amusement and Recreation 8699 Misc Membership Organizations 8999 Misc Services 7991 Physical Fitness Facilities 8811 Private Households 7941-7948 Professional Sports Clubs & Producers, Race Tracks 8621-8651 Professional Membership Organizations, Labor Unions, Civic Social & Fraternal Organizations, Political Organizations 7992-7997 Public Golf Courses, Amusements, Membership Sports & Recreation Clubs 8661 Religious Organizations 7922-7929 Theatrical Producers, Bands, Orchestras, Actors * If the group s SIC code appears above and the group offers Aetna medical, the dental rates for Loaded Industries apply. If the group s SIC code appears above and the group does not offer Aetna medical, the group is not eligible for Aetna dental products.
SIC Codes for Loaded Industries* SIC Range SIC Description 7319 Advertising, Misc 7800-7910 Amusement, Recreation & Entertainment 7912-7921 7930-7932 7934-7940 7949-7990 7998 8600-8610 8612-8620 8652-8660 8662-8698 Associations & Trusts 5511-5599 Auto Dealerships 7231-7241 Beauty & Barber Shops 7331-7338 Direct Mailing, Secretarial Services 8700-8799 Engineering & Mgmt Services 7000-7099 Hotels 9721 International Affairs 3911-3915 Jewelry Manufacturing 8100-8199 Legal 8000-8059 8071-8099 Medical Groups 7389 Misc Business Services 7379 Misc Computer Services 7692-7699 Misc Repair 5271 Mobile Home Dealers 4111-4121 Passenger Transportation 7221 Photo Studios 7384 Photofinishing Labs 6500-6799 Real Estate 7251-7299 Repairs, Cleaning, Personal Services 5800-5899 Restaurants 8211-8299 Schools, Libraries, Education 0761-0783 Seasonal Employees 7381-7382 Security Systems, Armored Cars 8800-8810 8812-8899 Private Households 8300-8499 Social Services; Museums, Art Galleries, Botanical Gardens 7631 Watch, Clock & Jewelry Repair * If the group s SIC code appears at left, dental rates for Loaded Industries apply to the group.