Rates for Unloaded Industries* Option 2: DMO Access 2 to 9 $19.30 $35.90 $36.30 $53.10 10 to 25 $17.60 $32.80 $36.20 $51.60 26 to 50 $16.70 $31.30 $34.60 $49.20 Option 3: Freedom-of-Choice 2 to 9 $29.50 $58.40 $51.40 $79.70 10 to 25 $26.80 $53.40 $54.40 $80.90 26 to 50 $25.50 $50.90 $51.70 $77.10 Option 4: PPO Max 2 to 9 $36.10 $72.20 $70.50 $106.50 10 to 25 $33.20 $65.90 $64.30 $97.20 26 to 50 $31.40 $62.80 $61.30 $92.60 Option 5: Active PPO 2 to 9 $40.40 $80.20 $78.40 $118.60 10 to 25 $36.70 $73.30 $83.10 $119.80 26 to 50 $35.00 $69.90 $79.10 $114.00 * if the group s SIC code does not appear on the list of Loaded Industries or Ineligible Industries, these rates apply. Option 6; Consumer-Directed Dental Fund 2 to 9 $21.00 $41.00 $56.10 $71.00 10 to 25 $19.50 $37.80 $52.30 $66.40 26 to 50 $18.60 $36.10 $49.90 $63.30 Option 7: PPO Max 1000 2 to 9 $31.60 $63.60 $61.90 $93.60 10 to 25 $28.90 $57.90 $56.50 $85.50 26 to 50 $27.60 $55.30 $53.80 $81.50 Option 8: Preventive Care PPO Max 2 to 9 $16.10 $30.90 $35.90 $50.60 10 to 25 $14.70 $28.30 $33.00 $46.20 26 to 50 $14.10 $27.10 $31.10 $44.00
Rates for Unloaded Industries* Voluntary Option 2: DMO Access 3 to 9 $20.80 $38.80 $39.30 $57.30 10 to 25 $19.00 $35.40 $39.20 $55.70 26 to 50 $18.10 $33.80 $37.40 $53.20 Voluntary Option 3: Freedom-of-Choice 3 to 9 $31.50 $63.20 $55.70 $86.00 10 to 25 $29.10 $57.60 $58.50 $87.30 26 to 50 $27.80 $55.20 $56.00 $83.20 Voluntary Option 4: PPO Max 3 to 9 $39.00 $78.00 $76.10 $115.10 10 to 25 $35.80 $71.20 $69.40 $105.00 26 to 50 $34.00 $67.90 $66.10 $100.10 Voluntary Option 5: Preventive Care 3 to 9 $17.80 $34.20 $39.70 $55.70 10 to 25 $16.20 $31.00 $36.10 $50.80 26 to 50 $15.50 $29.70 $34.50 $48.50 * 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: DMO Access 2 to 9 $21.20 $39.50 $39.90 $58.40 10 to 25 $19.40 $36.10 $39.80 $56.80 26 to 50 $18.40 $34.40 $38.10 $54.10 Option 3: Freedom-of-Choice 2 to 9 $32.50 $64.20 $56.50 $87.70 10 to 25 $29.50 $58.70 $59.80 $89.00 26 to 50 $28.10 $56.00 $56.90 $84.80 Option 4: PPO Max 2 to 9 $39.70 $79.40 $77.60 $117.20 10 to 25 $36.50 $72.50 $70.70 $106.90 26 to 50 $34.50 $69.10 $67.40 $101.90 Option 5: Active PPO 2 to 9 $44.40 $88.20 $86.20 $130.50 10 to 25 $40.40 $80.60 $91.40 $131.80 26 to 50 $38.50 $76.90 $87.00 $125.40 * if group s SIC code appears on the list of Loaded Industries, these rates apply. If the group s SIC code appears on the list of Ineligible Industries and the group is offering an Aetna medical plan, these rates apply. Option 6: Consumer-Directed Dental Fund 2 to 9 $23.10 $45.10 $61.70 $78.10 10 to 25 $21.50 $41.60 $57.50 $73.00 26 to 50 $20.50 $39.70 $54.90 $69.60 Option 7: PPO Max 1000 2 to 9 $34.80 $70.00 $68.10 $103.00 10 to 25 $31.80 $63.70 $62.20 $94.10 26 to 50 $30.40 $60.80 $59.20 $89.70 Option 8: Preventive Care PPO Max 2 to 9 $17.70 $34.00 $39.50 $55.70 10 to 25 $16.20 $31.10 $36.30 $50.80 26 to 50 $15.50 $29.80 $34.20 $48.40
Rates for Loaded Industries* Voluntary Option 2: DMO Access 3 to 9 $22.90 $42.70 $43.20 $63.00 10 to 25 $20.90 $38.90 $43.10 $61.30 26 to 50 $19.90 $37.20 $41.10 $58.50 Voluntary Option 3: Freedom-of-Choice 3 to 9 $34.70 $69.50 $61.30 $94.60 10 to 25 $32.00 $63.40 $64.40 $96.00 26 to 50 $30.60 $60.70 $61.60 $91.50 Voluntary Option 4: PPO Max 3 to 9 $42.90 $85.80 $83.70 $126.60 10 to 25 $39.40 $78.30 $76.30 $115.50 26 to 50 $37.40 $74.70 $72.70 $110.10 Voluntary Option 5: Preventive Care 3 to 9 $19.60 $37.60 $43.70 $61.30 10 to 25 $17.80 $34.10 $39.70 $55.90 26 to 50 $17.10 $32.70 $38.00 $53.40 * if group s SIC code appears on the list of Loaded Industries, the above rates apply. If the group s SIC code appears on the list of Ineligible Industries and the group is offering an Aetna medical plan, the above 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.