HomeMy WebLinkAbout05.a. Receive update on employee benefits for calendar year 2021 Page 1 of 9
Item 5.a.
CENTRAL SAN
■ Em
September 8, 2020
TO: ADMINISTRATION COMMITTEE
FROM: TEJI O'MALLEY, HUMAN RESOURCES AND ORGANIZATIONAL
DEVELOPMENT MANAGER
REVIEWED BY: ROGER S. BAILEY, GENERAL MANAGER
SUBJECT: RECEIVE UPDATE ON EMPLOYEE BENEFITS FOR CALENDAR YEAR
2021
Please see the attached memo (Attachment 1).
Strategic Plan re-In
GOAL THREE:Fiscal Responsibility
Strategy 2—Ensure integrity and transparency in financial management
GOAL FOUR: Workforce Development
Strategy 2—Foster relationships across all levels of Central San
ATTACHMENTS:
1. Memo
September 8, 2020 Special ADMIN Committee Meeting Agenda Packet- Page 94 of 105
Page 2 of 9
CENTRAL CONTRA COSTA
SANITARY DISTRICT
September 8, 2020
TO: ADMINISTRATION COMMITTEE
VIA: ROGER S. BAILEY, GENERAL MANAGER
FROM: TEJI OWALLEY, HUMAN RESOURCES AND ORGANIZATIONAL
DEVELOPMENT MANAGER
SUBJECT: RECEIVE UPDATE ON EMPLOYEE BENEFITS FOR CALENDAR YEAR
2021
This memo is to provide information to the Administration Committee and Board of
Directors regarding the changes to employee benefits due to the completion of benefit
renewal negotiations as well as the annual changes to the CalPERS premium rates.
All updated rates for Medical, Dental, and ancillary benefit coverage will go into effect
on January 1, 2021.
MEDICAL COVERAGE
Employees and retirees are eligible to choose any plan that is offered by CalPERS;
however, Central San will only pay 100 percent of the premium cost, up to the family
rate, of the "core plans". Retirees contribute towards any premium costs if required
based upon their tier at the time of retirement.
For active and non-Medicare eligible retirees, the core plans are Kaiser Permanente
and HealthNet SmartCare. For Medicare-eligible retirees, the core plans are Kaiser
Senior Advantage and United Healthcare. If a more expensive plan is chosen, the
employee or retiree is required to pay the District the difference between the highest
cost core plan and the chosen plan.
On July 14, CalPERS adopted the final rate adjustments to be effective January 2021,
as well as any other plan changes. The rate adjustments, both increases and
decreases, will result in an overall average premium increase of 4.32% for all of their
plans. On average, the health maintenance organization (HMO) plans will increase by
an average of 4.44%, the preferred provider organization (PPO) plans will increase by
an average of 8.54%, and the Medicare HMO and PPO plans will decrease by 4.46%
and 0.65% respectively. For reference, the Bay Area region premiums for 2020 and
2021 are enclosed.
September 8, 2020 Special ADMIN Committee Meeting Agenda Packet- Page 95 of 105
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Central San
Receive Update on Employee Benefits for Calendar Year 2021
Page 2 of 5
Central San's rate adjustments will result in an overall average premium increase of
approximately 6.1%, resulting in an annual cost increase of $521,851. The District had
assumed a premium increase of 7.25% in the FY 2020-21 budget. These rate
adjustments are the main drivers of Central San's annual cost changes, and the annual
cost change amount is also determined by which plans are chosen by the individual
active employees and retirees.
The following chart shows current (up to December 31, 2020) medical monthly premium
rates, the rate adjustments, and future (calendar year 2021) monthly premium rates for
the core plans for active employees and retirees within the Bay Area region:
Kaiser Health Net SmartCare
Current 2021 Current 2021
Actives Monthly Adjustment Monthly Monthly Adjustment Monthly
Premium Premium Premium Premium
Rates Rates Rates Rates
Single $768.49 5.87% $813.64 $1,000.52 11.96% $1,120.21
2-Party $1,536.98 5.87% $1,627.28 $2,001.04 11.96% $2,240.42
Family $1,998.07 5.87% $2,115.46 $2,601.35 11.96% $2,912.55
Kaiser Senior Advantage United Healthcare
Current 2021 Current 2021
Retirees Monthly Adjustment Monthly Monthly Adjustment Monthly
Premium Premium Premium Premium
Rates Rates Rates Rates
Single $339.43 -4.60% $324.48 $327.03 -4.97% $311.56
2-Party $678.86 -4.60% $648.96 $654.06 -4.97% $623.12
Family $1018.29 -4.60% $973.44 $981.09 -4.97% $934.68
With the costs for CalPERS healthcare plans now known for all of FY 2020-21, the
projected savings versus the budgeted amount for health costs can be calculated.
Medical costs for active employees and retirees and Medicare reimbursement for
retirees are projected to total $9.47 million, against the budgeted amount of $9.55
million, for a projected savings of $80,000. It should be noted that actual costs could
differ slightly from this projection as a result of staff turnover or active employees or
retirees switching plans in open enrollment this fall.
ALL OTHER BENEFITS (NON-MEDICAL)
Dental Coverage
Dental coverage is provided through Delta Dental at no cost to the employees and their
dependents, and retirees may pay a portion based upon their tier at the time of
retirement. The premium rates will decrease by 1 .0%, resulting in an annual cost
September 8, 2020 Special ADMIN Committee Meeting Agenda Packet- Page 96 of 105
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Central San
Receive Update on Employee Benefits for Calendar Year 2021
Page 3 of 5
savings of approximately $5,384. The District had assumed a premium increase of
3.75% in the FY 2020-21 budget.
Active Em to ees Retirees
Current Adjustment 2021 Current Adjustment 2021
Monthly Monthly Monthly Monthly
Premium Premium Premium Premium
Rates Rates Rates Rates
Single $67.90 -1.03% $67.20 $66.40 -1.05% $65.70
Dual $119.50 -1.00% $118.30 $116.60 -1.03% $115.40
Family $189.90 -1.00% $188.00 $186.10 -1.02% $184.20
Vision Plan
A vision plan is provided through VSP at no cost to the employees and their
dependents, and retirees may pay a portion based upon their tier at the time of
retirement. The premium rates reflect no rate increase. The District had assumed a
premium increase of 3.00% in the FY 2020-21 budget.
Active Employees Retirees
Current Adjustment FY 2020-21 Current Adjustment FY 2020-21
Monthly Monthly Monthly Monthly
Premium Premium Premium Premium
Rates Rates Rates Rates
Single $6.70 0% $6.70 $7.70 0% $7.70
Dual $11.60 0% $11.60 $13.60 0% $13.60
Family $17.70 0% $17.70 $15.70 0% $15.70
Basic Life, Accidental Death & Dismemberment (AD&D)
and Long-Term Disability (LTD) Coverage
Basic Life, AD&D, and LTD coverage is provided through Voya at no cost to Local One
and MS/CG members, as well as the Secretary of the District and the General Manager.
The Management Group and Unrepresented members pay for their Long-Term
Disability insurance premium. The premium rates reflect no rate increase. The District
had assumed a premium increase of 3.00% in the FY 2020-21 budget.
Voya Basic Life Voya AD&D Voya Dependent Life I
Current Adj.* 2021 Current Adj. 2021 Current Adj. 2021
Monthly Monthly Monthly Monthly Monthly Monthly
Premium Premium Premium Premium Premium Premium
Rate Rate Rate Rate Rate Rate
$0.315 per 0% $0.315 $0.026 per 0% $0.026 $0.370 0% $0.370 per
$1,000 per $1,000 per per unit unit
$1,000 $1,000
*Adjustment
September 8, 2020 Special ADMIN Committee Meeting Agenda Packet- Page 97 of 105
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Central San
Receive Update on Employee Benefits for Calendar Year 2021
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Vo a LTD
Current Monthly Adjustment 2021 Monthly
Premium Rate Premium Rate
$0.287 per$100 0% $0.287 per$100
Employee Assistance Program (EAP)
EAP coverage is provided through Managed Health Network (MHN) at no cost to the
employees and their dependents. The premium rates reflect no rate increase. The
District had assumed a premium increase of 3.00% in the FY 2020-21 budget.
Current Monthly Adjustment 2021 Monthly
Premium Rate Premium Rate
$3.72 0% $3.72
ONGOING FINANCIAL IMPACTS DUE TO TRANSITION TO CALIPERS
Effective July 1, 2019, the District transitioned all active employees and retirees to the
CalPERS medical plans. In early 2019, the District's actuarial service provider had
estimated, based on several assumptions, savings of $5.8 million as a result of this
transition. The FY 2019-20 costs had been projected to be $15 million with Central
San's previous medical plans, and the actual costs for FY 2019-20 were $8.9 million,
resulting in an actual savings of $6.1 million.
Furthermore, had the District not transitioned to CalPERS and stayed with the previous
medical plans, the FY 2020-21 cost would have been projected to be $15.9 million,
compared to the projected cost of CalPERS, which is $9.8 million, resulting in an
anticipated savings of $6.1 million.
Staff will be available to answer any questions or provide clarification during the
meeting.
September 8, 2020 Special ADMIN Committee Meeting Agenda Packet- Page 98 of 105
Updated: November 1,2019
CalPERS 2020 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2020
Alameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,EI Dorado,Glenn,Humboldt,Lake,Lassen,Marin,Mariposa,
Mendocino,Merced,Modoc,Mono,Monterey,Napa,Nevada,Placer,Plumas,Sacramento,San Benito,San Francisco,San Joaquin,
San Mateo,Santa Clara,Santa Cruz,Shasta,Sierra,Siskiyou,Solano,Sonoma,Stanislaus,Sutter,Tehama,Trinity,Tuolumne,Yolo,Yuba
Basic Monthly Premiums (B)
Plan Party Subscriber& Plan Party Subscriber& Plan Party
Plan Subscriber Code Rate 1 Dependent Code Rate 2+Dependents Code Rate
Anthem Blue Cross Del Norte $861.18 504 1 $1,722.36 504 2 $2,239.07 504 3
Anthem Blue Cross Select 868.98 506 1 1,737.96 506 2 2,259.35 506 3
Anthem Blue Cross Traditional 1,184.84 509 1 2,369.68 509 12 3,080.58 5091 3
Blue Shield Access+ 1,127.77 525 1 2,255.54 525 2 2,932.20 525 3
Blue Shield Access+EPO 1,127.77 524 1 2,255.54 524 2 2,932.20 524 3
Blue Shield Trio* 833.00 451 1 1,666.00 451 2 2,165.80 451 3
Health Net SmartCare 1,000.52 528 1 2,001.04 528 2 2,601.35 528 3
Kaiser Permanente 768.49 533 1 1,536.98 533 2 1,998.07 533 3
PERS Choice 861.18 548 1 1,722.36 548 2 2,239.07 548 3
PERS Select 520.29 557 1 Pa e 6 o`Q'58 557 2 1,352.75 557 3
PERS Care 1,133.14 566 1 2,266.28 566 2 2,946.16 566 3
Peace Officers Research Assoc of CA 774.00 592 1 1,699.00 592 2 2,199.00 592 3
UnitedHealthcare 899.94 576 1 1,799.88 576 2 2,339.84 576 3
Western Health Advantage 731.96 591 1 1,463.92 591 2 1,903.10 591 3
Supplement/Managed
Plan Party Subscriber& Plan Party Subscriber& Plan Party
Plan Subscriber Code Rate 1 Dependent Code Rate 2+Dependents Code Rate
Anthem Blue Cross Select Medicare
Preferred $388.15 455 4 $776.30 455 5 $1,164.45 455 6
Anthem Blue Cross Select Medicare 388.15 459 4 776.30 459 5 1,164.45 459 6
Preferred with Dental
Anthem Blue Cross Medicare Preferred 388.15 515 4 776.30 515 5 1,164.45 515 6
Anthem Blue Cross Medicare Preferred with 388.15 512 4 776.30 512 5 1,164.45 512 6
Dental/Vision'
Kaiser Permanente Senior Advantage 339.43 536 4 678.86 536 5 1,018.29 536 6
Kaiser Permanente Senior Advantage with 339.43 542 4 678.86 542 5 1,018.29 542 6
Dental'
PERS Choice Medicare Supplement 351.39 551 4 702.78 551 5 1,054.17 551 6
PERS Select Medicare Supplement 351.39 560 4 702.78 560 5 1,054.17 560 6
PERS Care Medicare Supplement 384.78 569 4 769.56 569 5 1,154.34 569 6
Peace Officers Research Assoc of CA 513.00 595 4 1,022.00 595 5 1,635.00 595 6
Medicare Supplement
UnitedHealthcare Medicare Advantage 327.03 579 4 654.06 579 5 981.09 579 6
UnitedHealthcare Medicare Advantage with 327.03 585 4 654.06 585 5 981.09 585 6
Dental/Vision3
*Blue Shield is introducing a new HMO health plan called Blue Shield Trio.This plan will be available in EI Dorado,Los Angeles,Nevada,Placer,Sacramento
and Yolo counties.
'Dental and Vision coverage is an additional$38.00 per member per month premium.You will be billed directly for this amount.
'Dental benefit is an additional$15.05 per member per month premium.You will be billed directly for this amount.
'Dental and Vision coverage is an additional$31.65 per member per month premium.You will be billed directly for this amount.
1
September 8,2020 Special ADMIN Committee Meeting Agenda Packet-Page 99 of 105
Updated: November 1,2019
CalPERS 2020 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2020
Alameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,EI Dorado,Glenn,Humboldt,Lake,Lassen,Marin,Mariposa,
Mendocino,Merced,Modoc,Mono,Monterey,Napa,Nevada,Placer,Plumas,Sacramento,San Benito,San Francisco,San Joaquin,
San Mateo,Santa Clara,Santa Cruz,Shasta,Sierra,Siskiyou,Solano,Sonoma,Stanislaus,Sutter,Tehama,Trinity,Tuolumne,Yolo,Yuba
Combination Monthly Premiums
Subscriber in M,
Subscriber in M,& Plan Party Subscriber in M,& Plan Party 1 Dependent in M,& Plan Party
Plan 1 Dependent in B Code Rate 2+Dependents in B Code Rate 1+Dependent in B Code Rate
Anthem Blue Cross Del Norte and Medicare
$1,212.57 505 7 $1,729.28 505 8 $1,219.49 505 9
Supplement
Anthem Blue Cross Select and Medicare 1,257.13 457 7 1,778.52 457 8 1,297.69 457 9
Preferred
Anthem Blue Cross Select and Medicare 1,257.13 460 7 1,778.52 460 8 1,297.69 460 9
Preferred with Dental'
Anthem Blue Cross Traditional HMO and 1,572.99 518 7 2,283.89 518 8 1,487.20 518 9
Medicare Preferred
Anthem Blue Cross Traditional HMO and 1,572.99 521 7 2,283.89 521 8 1,487.20 521 9
Medicare Preferred Dental/Vision'
Kaiser Permanente and Senior Advantage 1,107.92 539 7 1,56f9gg.01 539 8 1,139.95 539 9
Kaiser Permanente and Senior Advantage 1,107.92 545 7 Page17-pIi9.01 545 8 1,139.95 545 9
with DentalZ
PERS Choice and Medicare Supplement 1,212.57 554 7 1,729.28 554 8 1,219.49 554 9
PERS Select and Medicare Supplement 871.68 563 7 1,183.85 563 8 1,014.95 563 9
PERS Care and Medicare Supplement 1,517.92 572 7 2,197.80 572 8 1,449.44 572 9
Peace Officers Research Assoc of CA and 1,438.00 598 7 1,938.00 598 8 1,522.00 598 9
Medicare Supplement
U n ited Healthcare and Medicare Advantage 1,226.97 582 7 1,766.93 582 8 1,194.02 582 9
UnitedHealthcare and Medicare Advantage 1,226.97 588 7 1,766.93 588 8 1,194.02 588 9
with Dental/Vision3
Combination Monthly Premiums(Continued)
Subscriber in B,
Subscriber in B,& Plan Party Subscriber in B,& Plan Party 1 Dependent in M,& Plan Party
Plan 1 Dependent in M Code Rate 2+Dependents in M Code Rate 1+Dependent in B Code Rate
Anthem Blue Cross Del Norte and Medicare
$1,212.57 505 10 $1,563.96 505 11 $1,729.28 505 12
Supplement
Anthem Blue Cross Select and Medicare 1,257.13 457 10 1,645.28 457 11 1,778.52 457 12
Preferred
Anthem Blue Cross Select and Medicare 1,257.13 460 10 1,645.28 460 11 1,778.52 460 12
Preferred with Dental
Anthem Blue Cross Traditional HMO and 1,572.99 518 10 1,961.14 518 11 2,283.89 518 12
Medicare Preferred
Anthem Blue Cross Traditional HMO and 1,572.99 521 10 1,961.14 521 11 2,283.89 521 12
Medicare Preferred Dental/Vision
Kaiser Permanente and Senior Advantage 1,107.92 539 10 1,447.35 539 11 1,569.01 539 12
Kaiser Permanente and Senior Advantage 1,107.92 545 10 1,447.35 545 11 1,569.01 545 12
with Dental
PERS Choice and Medicare Supplement 1,212.57 554 10 1,563.96 554 11 1,729.28 554 12
PERS Select and Medicare Supplement 871.68 563 10 1,223.07 563 11 1,183.85 563 12
PERS Care and Medicare Supplement 1,517.92 572 10 1,902.70 572 11 2,197.80 572 12
Peace Officers Research Assoc of CA and 1,283.00 598 10 1,896.00 598 11 1,783.00 598 12
Medicare Supplement
U n ited Healthcare and Medicare Advantage 1,226.97 582 10 1,554.00 582 11 1,766.93 582 12
UnitedHealthcare and Medicare Advantage 1,226.97 588 10 1,554.00 588 11 1,766.93 588 12
with Dental/Vision'
'Dental and Vision coverage is an additional$38.00 per member per month premium.You will be billed directly for this amount.
2Dental benefit is an additional$15.05 per member per month premium.You will be billed directly for this amount.
3Dental and Vision coverage is an additional$31.65 per member per month premium.You will be billed directly for this amount.
2
September 8,2020 Special ADMIN Committee Meeting Agenda Packet-Page 100 of 105
Page 8 of 9
Updated: July 21,2020
CalPERS 2021 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1,2021
IS
lameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,EI Dorado,Glenn,Humboldt,Lake,Lassen,Marin,Mariposa,
endocino,Merced,Modoc,Mono,Monterey,Napa,Nevada,Placer,Plumas,Sacramento,San Benito,San Francisco,San Joaquin,
an Mateo,Santa Clara,Santa Cruz,Shasta,Sierra,Siskiyou,Solano,Sonoma,Stanislaus,Sutter,Tehama,Trinity,Tuolumne,Yolo,Yuba
Basic Monthly Premiums(B)
Plan Party Subscriber& Plan Party Subscriber& Plan Party
Plan Subscriber Code Rate 1 Dependent Code Rate 21 Dependents Code Rate
Anthem Blue Cross Del Norte $935.84 504 1 $1,871.68 504 2 $2,433.18 504 3
Anthem Blue Cross Select 925.60 506 1 1,851.20 506 2 2,406.56 506 3
Anthem Blue Cross Traditional 1,307.86 509 1 2,615.72 509 2 3,400.44 509 3
Blue Shield Access+ 1,170.08 525 1 2,340.16 525 2 3,042.21 525 3
Blue Shield Access+EPO 1,170.08 524 1 2,340.16 524 2 3,042.21 524 3
Blue Shield Trio* 880.50 451 1 1,761.00 451 2 2,289.30 451 3
Health NetSmartCare 1,120.21 528 1 2,240.42 528 2 2,912.55 528 3
Kaiser Permanente 813.64 533 1 1,627.28 533 2 2,115.46 533 3
PERS Choice 935.84 548 1 1,871.68 548 2 2,433.18 548 3
PERS Select 566.67 557 1 1,133.34 557 2 1,473.34 557 3
PERSCare 1,294.69 566 1 2,589.38 566 2 3,366.19 566 3
Peace Officers Research Assoc of CA 799.00 592 1 1,725.00 592 2 2,199.00 592 3
UnitedHealthcare SignatureValue Alliance 941.17 576 1 1,882.34 576 2 2,447.04 576 3
Western Health Advantage 757.02 591 1 1,514.04 591 2 1,968.25 591 3
�Supplement/Managed
Plan Party Subscriber& Plan Party Subscriber& Plan Party
Plan Subscriber Code Rate 1 Dependent Code Rate 2+Dependents Code Rate
Anthem Blue Cross Select and Medicare $383.37 455 4 $766.74 455 5 $1,150.11 455 6
Preferred
Anthem Blue Cross Select and Medicare
383.37 459 4 766.74 459 5 1,150.11 459 6
Preferred PPO DentalNision'
Anthem Blue Cross Medicare Preferred 383.37 515 4 766.74 515 5 1,150.11 515 6
Anthem Blue Cross Medicare Preferred 383.37 512 4 766.74 512 5 1,150.11 512 6
Dental/Vision'
Kaiser Permanente Senior Advantage 324.48 536 4 648.96 536 5 973.44 536 6
Kaiser Permanente Senior Advantage plus 324.48 542 4 648.96 542 5 973.44 542 6
Dental'
PERS Choice Medicare Supplement 349.97 551 4 699.94 551 5 1,049.91 551 6
PERS Select Medicare Supplement 349.97 560 4 699.94 560 5 1,049.91 560 6
PERSCare Medicare Supplement 381.25 569 4 762.50 569 5 1,143.75 569 6
Peace Officers Research Assoc of CA 513.00 595 4 1,022.00 595 5 1,635.00 595 6
Medicare Supplement
UnitedHealthcare Group Medicare Advantage 311.56 579 4 623.12 579 5 934.68 579 6
UnitedHealthcare Group Medicare Advantage 311.56 585 4 623.12 585 5 934.68 585 6
PPO DentalNision'
*Blue Shield Trio is only available in EI Dorado,Nevada,Placer,Sacramento,and Yolo.
'Dental and Vision coverage is an additional$38.00 per member per month premium.You will be billed directly for this amount.
2Dental benefit is an additional$15.05 per member per month premium.You will be billed directly for this amount.
3Dental and Vision coverage is an additional$25.55 per member per month premium.You will be billed directly for this amount.
1
September 8, 2020 Special ADMIN Committee Meeting Agenda Packet- Page 101 of 105
Page 9 of 9
Updated: July 21,2020
CalPERS 2021 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1,2021
Alameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,EI Dorado,Glenn,Humboldt,Lake,Lassen,Marin,Mariposa,
Mendocino,Merced,Modoc,Mono,Monterey,Napa,Nevada,Placer,Plumas,Sacramento,San Benito,San Francisco,San Joaquin,
San Mateo,Santa Clara,Santa Cruz,Shasta,Sierra,Siskiyou,Solano,Sonoma,Stanislaus,Sutter,Tehama,Trinity,Tuolumne,Yolo,Yuba
Combination Monthly Premiums
Subscriber in M,
Subscriber in M,& Plan Party Subscriber in M,& Plan Party 1 Dependent in M,& Plan Party
Plan 1 Dependent in B Code Rate 2+Dependents in B Code Rate 1+Dependent in B Code Rate
Anthem Blue Cross Del Norte and Medicare $1,285.81 505 7 $1,847.31 505 8 $1,261.44 505 9
Supplement
Anthem Blue Cross Select and Medicare 1,308.97 457 7 1,864.33 457 8 1,322.10 457 9
Preferred
Anthem Blue Cross Select and Medicare 1,308.97 460 7 1,864.33 460 8 1,322.10 460 9
Preferred PPO Dental/Vision'
Anthem Blue Cross Traditional HMO and 1,691.23 518 7 2,475.95 518 8 1,551.46 518 9
Medicare Preferred
Anthem Blue Cross Medicare Preferred 1,691.23 521 7 2,475.95 521 8 1,551.46 521 9
Dental/Vision'
Kaiser Permanente and Senior Advantage 1,138.12 539 7 1,626.30 539 8 1,137.14 539 9
Kaiser Permanente Senior Advantage plus 1,138.12 545 7 1,626.30 545 8 1,137.14 545 9
Dental2
PERS Choice and Medicare Supplement 1,285.81 554 7 1,847.31 554 8 1,261.44 554 9
PERS Select and Medicare Supplement 916.64 563 7 1,256.64 563 8 1,039.94 563 9
PERSCare and Medicare Supplement 1,675.94 572 7 2,452.75 572 8 1,539.31 572 9
Peace Officers Research Assoc of CA and 1,439.00 598 7 1,913.00 598 8 1,496.00 598 9
Medicare Supplement
U n ited Healthcare Group Medicare Advantage 1,252.73 582 7 1,817.43 582 8 1,187.82 582 9
U n ited Healthcare Group Medicare Advantage 1,252.73 588 7 1,817.43 588 8 1,187.82 588 9
with Dental/Vision3
�Combination Monthly Premiums(Continued)
Subscriber in B,
Subscriber in B,& Plan Party Subscriber in B,& Plan Party 1 Dependent in M,& Plan Party
Plan 1 Dependent in M Code Rate 2+Dependents in M Code Rate 1+Dependent in B Code Rate
Anthem Blue Cross Del Norte and Medicare $1,285.81 505 10 $1,635.78 505 11 $1,847.31 505 12
Supplement
Anthem Blue Cross Select and Medicare 1,308.97 457 10 1,692.34 457 11 1,864.33 457 12
Preferred
Anthem Blue Cross Select and Medicare 1,308.97 460 10 1,692.34 460 11 1,864.33 460 12
Preferred with Dental/Vision'
Anthem Blue Cross Traditional HMO and 1,691.23 518 10 2,074.60 518 11 2,475.95 518 12
Medicare Preferred
Anthem Blue Cross Traditional HMO and 1,691.23 521 10 2,074.60 521 11 2,475.95 521 12
Medicare Preferred Dental/Vision'
Kaiser Permanente and Senior Advantage 1,138.12 539 10 1,462.60 539 11 1,626.30 539 12
Kaiser Permanente and Senior Advantage 1,138.12 545 10 1,462.60 545 11 1,626.30 545 12
with Dental'
PERS Choice and Medicare Supplement 1,285.81 554 10 1,635.78 554 11 1,847.31 554 12
PERS Select and Medicare Supplement 916.64 563 10 1,266.61 563 11 1,256.64 563 12
PERSCare and Medicare Supplement 1,675.94 572 10 2,057.19 572 11 1 2,452.75 572 12
Peace Officers Research Assoc of CA and 1,308.00 598 10 1,825.00 598 11 1,782.00 598 12
Medicare Supplement
UnitedHealthcare Group Medicare Advantage 1,252.73 582 10 1,564.29 582 11 1,817.43 582 12
UnitedHealthcare Group Medicare Advantage 1,252.73 588 10 1,564.29 588 11 1,817.43 588 12
PPO Dental/Vision'
'Dental and Vision coverage is an additional$38.00 per member per month premium.You will be billed directly for this amount.
2Dental benefit is an additional$15.05 per member per month premium.You will be billed directly for this amount.
'Dental and Vision coverage is an additional$25.55 per member per month premium.You will be billed directly for this amount.
2
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