Step 1: Use your ZIP code to find rate code.
Step 2: Use your rate code to find your 2021 premium.
gehadental.com/Rates
Find your state and the first three digits of your ZIP code in the chart below to determine your rate code. Use that code on the next page to determine your 2021 dental premium. gehadental.com/Rates
High Option
Biweekly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
First 3 digits of ZIP code
Rate code
First 3 digits of ZIP code
Rate code
First 3 digits of ZIP code
Rate code
State
State
State
$16.89
$19.00
$20.77
$23.21
$25.16
Self Only
460-462, 470, 472, 473 2
1 2
AL, AR, FM, GU, IA, MH, MP, MS, ND, NE, PR, PW, VI ID, LA, MO, MT, NC, OK, SC, SD, TN, UT, VT AS, DE, HI, NM, OR
IN IN IN KS KS KY KY
NY NY
127, 129-139, 144-149
3 1 2 1 2 1 2 4
463, 464
Rest of state
$33.78
$37.97
$41.54
$46.41
$50.34
Self Plus One
1
Entire state or territory
Rest of state 660-662, 666 Rest of state
430-433, 437, 440-443, 446, 447, 450-455, 459
2
OH
$50.68
$57.00
$62.30
$69.65
$75.56
Self and Family
1 4 5 3 1
OH
Rest of state
2
Entire state
Retirees monthly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
PA PA PA PA
172-174
410
180, 181, 183
Rest of state
3
Entire state or territory
$36.60
$41.17
$45.00
$50.29
$54.51
Self Only
189-196
MA MA MD MD MD ME ME
012
CO, DC, NH, RI
Rest of state
Rest of state
$73.19
$82.27
$90.00
$100.56
$109.07
4
Self Plus One
Entire state
755-759, 763-769, 776-779, 783-785, 788-799, 885
205-212, 214, 216, 217 4
5 3 2
AK AZ AZ
Entire state 850-853, 864 Rest of state
1
TX
$109.81
$123.50
$134.98
$150.91
$163.71
Self and Family
3 2 4 3
219
Rest of state
3 2
TX TX VA VA
733, 786-787 Rest of state
Standard Option
039-042
900-931, 933-935, 939-952, 954, 956-959
5
CA
Biweekly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
Rest of state
201, 203, 205, 220-227 4
4
CA
Rest of state
2 5 3 4 3 2 4 1 2 1 5
Rest of state
3
MI
480-485
$9.84
$11.04
$12.09
$13.50
$14.63
Self Only
5
CT
064-069
WA WA WA
980-985
2
MI
Rest of state
$19.68
$22.08
$24.14
$26.98
$29.24
Self Plus One
986
4
CT
Rest of state
3
MN
550-555, 563
Rest of state
3
FL
329-334, 349
$29.51
$33.11
$36.21
$40.46
$43.87
Self and Family
2
MN
Rest of state
WI WI
540
2
FL
Rest of state
3
NJ
080-084
Retirees monthly
Rate code 1*
Rate code 2*
Rate code 3*
Rate code 4*
Rate code 5*
Rest of state
300-303, 305, 306, 311, 399
3
GA
5
NJ
Rest of state
WV WV WY WY
254
$21.32
$23.92
$26.20
$29.25
$31.70
Self Only
5
NV
897
Rest of state
2 3 2 1
GA
Rest of state 600-609, 613
834
IL IL IL
$42.64
$47.84
$52.30
$58.46
$63.35
Self Plus One
3 5 4
NV NY NY
Rest of state
620, 622
Rest of state
005, 100-119, 124-126
$63.94
$71.74
$78.46
$87.66
$95.05
Self and Family
Rest of state
INTL
All International
063
* Rate based on member’s primary state of residence.
6
7
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