HomeMy WebLinkAbout5.a. Receive update on Employee Benefits for Calendar Year 2023 Page 1 of 11
Item 5.a.
CENTRAL SAN
Y-109-ITMEN ME
September 6, 2022
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
2023
Staff will review the attached memo and Health Premiums for 2022 and 2023 at the meeting.
Strategic Plan Tie-In
GOAL FOUR: Governance and Fiscal Responsibility
Strategy 1 - Promote and uphold ethical behavior, openness, and accessibility
ATTACHMENTS:
1. Employee Benefits Memo
2. CalPERS 2022 Regional Health Premiums
3. CalPERS 2023 Regional Health Premiums
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 39 of 51
Page 2 of 11
Attachment 1
CENTRAL CONTRA COSTA
SANITARY DISTRICT
September 6, 2022
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
2023
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, 2023.
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 employees 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.
In July of 2022, CalPERS adopted the final rate adjustments to be effective January 2023,
as well as any other plan changes. The rate adjustments, both increases and decreases,
will result in an overall average premium increase of 6.75% for all of their plans.
On average, the health maintenance organization (HMO) plans will increase by an
average of 4.35%, the preferred provider organization (PPO) plans will increase by an
average of 15.76%, and the Medicare HMO and PPO plans will increase by an average of
3.69%. For reference, the Bay Area region (Region 1) premiums for 2022 and 2023 are
enclosed.
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 40 of 51
Administration Committee Page 3 of 11
September 6, 2022
Page 2 of 4
Central San's rate adjustments will result in an overall average premium increase of
approximately 4.3% resulting in an annual cost increase of $195,475. The District assumed
a premium increase of 5.3% in the second half of FY 2022-23. This will result in a modest
savings in the O&M budget. However, actual savings may vary dependent on staff turnover or
active employees/retirees switching plans during open enrollment this fall.
The following chart shows current (up to December 31, 2022) medical monthly premium
rates, the rate adjustments, and future (calendar year 2023) monthly premium rates for the
core plans for active employees and retirees within the Bay Area region:
Kaiser Health Net SmartCare
Current 2023 Current 2023
Actives Monthly Ad• Monthly Monthly Ad• Monthly
Premium Premium Premium Premium
Rates Rates Rates Rates
Single $857.06 6.61% $913.74 $1,153.00 1 .86% $1 ,174.50
Dual $1,714.12 6.61% $1,827.48 $2,306.00 1.86% $2,349.00
Family $2,228.36 6.61% $2,375.72 $2,997.80 1.86% $3,053.70
Kaiser Senior Advanta a United Healthcare
Current 2023 Current 2023
Retirees Monthly Add Monthly Monthly Adj. Monthly
Premium Premium Premium Premium
Rates Rates Rates Rates
Single $302.53 -6.81% 283.25 $294.65 1.71% $299.68
Dual $605.06 -6.81% 566.50 $589.30 1.71% $599.36
Family $907.59 -6.81% 849.75 $883.95 1.71% $899.04
For reference, I have also included a current census of our active employees and retirees
based on their plan selection in calendar year 2022.
I
■Kaiser ■Kaiser Senior Adv HN Smartcare ■PERS Platinum
■United Healthcare Medicare PERS Platinum Medicare ■Other
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 41 of 51
Administration Committee Page 4 of 11
September 6, 2022
Page 3 of 4
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 1.20%, resulting in an annual cost savings of
approximately $10,351 . The District assumed a premium increase of 3.80% in the
FY 2022-23 budget.
Active Employees Retirees
Current 2023 Current 2023
Monthly Ad. Monthly Monthly Ad. Monthly
Premium Premium Premium Premium
Rates Rates Rates Rates
Single $69.80 -1.20% $69.00 $68.20 -1.20% $67.40
Dual $122.80 -1.20% $121.40 $119.80 -1.20% $118.40
Family $195.10 -1.20% $192.80 $191.10 -1.20% $188.90
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 assumed a premium increase of 3.80% in the
FY 2022-23 budget.
Active Employees Retirees
Current 2023 Current 2023
Monthly Add Monthly Monthly Add 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
no premium increase in the FY 2022-23 budget.
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 42 of 51
Administration Committee Page 5 of 11
September 6, 2022
Page 4 of 4
Voya Basic Life Voya AD&D Voya Dependent Life
Current 2023 Current 2023 Current 2023
Monthly Monthly Monthly Monthly Monthly Monthly
Premium Add' Premium Premium Add' Premium Premium Add' Premium
Rate Rate Rate Rate Rate Rate
$0.315 per $0.315 per $0.026 per $0.026 per $0.370 $0.370
$1,000 0% $1,000 $1,000 0% $1,000 per unit 0% per unit
Voya LTD
Current Monthly 2023 Monthly
Premium Rate Add' 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 no premium increase in the FY 2022-23 budget.
EAP
Current Monthly 2023 Monthly
Premium Rate Add' Premium Rate
$3.72 0% $3.72
Open Enrollment will begin on September 19, 2022, and end on October 14, 2022.
Staff will be available to answer any questions or provide clarification during the meeting.
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 43 of 51
Page 6 of 11
Updated:September 14,2021
Attachment 2
CalPERS 2022 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1,2022
Alameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,El Dorado,Glenn,Humboldt,Lake,Lassen,Merin,Mariposa,Mendocino,Merced,Modoc,
Mono,Monterey,Napa,Nevada,Placer,Plumes,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
III
Plan Party Party Subscriber&1 Plan Party Party Subscriber&2+ Plan Party Party
Plan Subscriber Code Code Rate Dependent Code Code Rate Dependents Code Code Rate
Anthem Blue Cross Del Norte $1,057.01 504 1 1 $2,114.02 504 2 2 $2,748.23 504 3 3
Anthem Blue Cross Select 1,015.81 506 1 1 2,031.62 506 2 2 2,641.11 506 3 3
Anthem Blue Cross Traditional 1,304.00 509 1 1 2,608.00 509 2 2 3,390.40 509 3 3
Blue Shield Access+ 1,116.01 525 1 1 2,232.02 525 2 2 2,901.63 525 3 3
Blue Shield Access+EPO 1,116.01 524 11 1 2,232.02 524 2 2 2,901.63 524 3 3
Blue Shield Trio* 898.54 451 1 1 1 1,797.08 451 21 2 2,336.20 451 31 3
Health Net SmartCare 1,153.00 528 1 1 1 2,306.00 528 2 2 2,997.80 528 3 3
Kaiser Permanente 857.06 533 1 1 1 1,714.12 533 2 2 2,228.36 533 3 3
PERS Gold 701.23 613 1 1 1,402.46 613 2 21 1,823.20 613 3 3
PERS Platinum 1,057.01 601 1 11 2,114.02 601 2 2 2,748.23 601 3 3
Peace Officers Research Assoc of CA 799.00 592 1 1 1,725.00 592 2 2 2,219.00 592 3 3
UnitedHealthcare SignatureValue Alliance 1,020.28 576 1 1 2,040.56 576 2 2 2,652.73 576 3 3
Western Health Advantage 741.26 591 1 1 1,482.52 591 2 2 1,927.28 591 3 3
Supplement/Managed Medicare Monthly Premiums(M) -4911100--
Plan Party Party Subscriber&1 Plan Party Party Subscriber&2+ Plan Party Party
Plan Subscriber Code Code Rate Dependent Code Code Rate Dependents Code Code Rate
Anthem Blue Cross Select Medicare
Preferred $360.19 455 1 4 $720.38 455 2 5 $1,080.57 455 3 6
Anthem Blue Cross Select Medicare
Preferred with Dental/Vision' 360.19 459 1 4 720.38 459 2 5 1,080.57 459 3 6
Anthem Blue Cross Medicare Preferred 360.19 5151 11 4 720.38 5151 21 5 1,080.57 5151 31 6
Anthem Blue Cross Medicare Preferred with
Dental/Vision' 360.19 512 1 4 720.38 512 2 5 1,080.57 512 3 6
Blue Shield Medicare 353.11 011 1 4 706.22 011 2 5 1,059.33 011 3 6
Blue Shield Medicare with Dental/Vision2 353.11 016 1 4 706.22 016 2 5 1,059.33 016 3 6
Kaiser Permanente Senior Advantage 302.53 536 1 4 605.06 536 2 5 907.59 536 3 6
Kaiser Permanente Senior Advantage with
Dental' 302.53 542 1 4 605.06 542 2 5 907.59 542 3 6
PERS Gold Medicare Supplement 377.41 616 1 4 754.82 616 2 5 1,132.23 616 3 6
PERS Platinum Medicare Supplement 381.94 605 1 4 763.88 605 2 5 1,145.82 605 3 6
Peace Officers Research Assoc of CA
Medicare Supplement 461.00 595 1 4 919.00 595 2 5 1,471.00 595 3 6
UnitedHealthcare Medicare Advantage Edge 347.21 476 1 4 694.42 476 2 5 1,041.63 476 3 6
UnitedHealthcare Medicare Advantage 294.65 579 1 4 589.30 1 579 2 5 883.95 579 3 6
UnitedHealthcare Medicare Advantage with
Dental/Vision" 294.65 585 1 4 589.30 585 2 5 883.95 585 3 6
Western Health Advantage Medicare
Advantage 314.94 035 1 1 4 629.88 035 2 5 944.82 035 3 6
*Blue Shield Trio is only available in El Dorado,Nevada,Placer,Sacramento,Santa Cruz,Stanislaus,and Yolo(partial county served)
'Dental and Vision coverage is an additional$38.00 Der member Der month Dremium.You will be billed directly for this amount.
`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$25.55 Der member Der month Dremium.You will be billed directiv for this amount.
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 44 of 51
Page 7 of 11
Updated:September 14,2021
CalPERS 2022 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1,2022
Alameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,El 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 Party Subscriber in M,&2+ Plan Party Party 1 Dependent in M,&1+ Plan Party Party
Plan 1 Dependent in B Code Code Rate Dependents in B Code Code Rate Dependent in B Code Code Rate
Anthem Blue Cross Del Norte and Medicare
Supplement $1,438.95 021 4 7 $2,073.16 21 5 8 $1,398.09 021 6 9
Anthem Blue Cross Select and Medicare
Preferred 1,376.00 4571 41 7 1,985.49 4571 51 8 1,329.87 4571 61 9
Anthem Blue Cross Select and Medicare
Preferred with Dental/Vision' 1,376.00 460 4 7 1,985.49 460 5 8 1,329.87 460 6 9
Anthem Blue Cross Traditional HMO and
Medicare Preferred 1,664.19 518 4 7 2,446.59 518 5 8 1,502.78 518 6 9
Anthem Blue Cross Traditional HMO and
Medicare Preferred Dental/Vision' 1,664.19 521 4 7 2,446.59 521 5 8 1,502.78 521 6 9
Blue Shield Access+and Medicare 1,469.12 049 4 7 2,138.73 491 51 8 1,375.83 0491 61 9
Blue Shield Access+and Medicare with
Dental/Vision2 1,469.12 0891 41 7 2,138.73 89 5 8 1,375.83 089 6 9
Blue Shield Access+EPO and Medicare 1,469.12 092 4 7 2,138.73 92 5 8 1,375.83 092 6 9
Blue Shield Access+EPO and Medicare with
Dental/Vision3 1,469.12 093 4 7 2,138.73 93 5 8 1,375.83 093 6 9
Blue Shield Trio and Medicare 1,251.65 094 4 7 1,790.77 94 5 8 1,245.34 094 6 9
Blue Shield Trio and Medicare with
Dental/Vision4 1,251.65 097 4 7 1,790.77 97 5 8 1,245.34 097 6 9
Kaiser Permanente and Senior Advantage 1,159.59 539 4 7 1,673.83 539 5 8 1,119.30 539 6 9
Kaiser Permanente Senior Advantage with
Dental5 1,159.59 545 4 7 1,673.83 545 5 8 1,119.30 545 6 9
PERS Gold and Medicare Supplement 1,078.64 619 4 7 1,499.38 619 5 8 1,175.56 619 6 9
PERS Platinum and Medicare Supplement 1,438.95 609 4 7 2,073.16 609 5 8 1,398.09 609 6 9
Peace Officers Research Assoc of CA and
Medicare Supplement 1,439.00 598 4 7 1,913.00 5981 5 8 1,496.00 5981 6 9
UnitedHealthcare SignatureValue Alliance
and Medicare Advantage Edge 1,367.49 6271 41 7 1,979.66 627 5 8 1,306.59 627 6 9
UnitedHealthcare SignatureValue Alliance
and Medicare Advantage 1,314.93 582 4 7 1,927.10 582 5 8 1,201.47 582 6 9
UnitedHealthcare SignatureValue Alliance
and Medicare Advantage with Dental/Vision' 1,314.93 588 4 7 1,927.10 588 5 8 1,201.47 588 61 9
Western Health Advantage and Medicare
Advantage 1,056.20 036 4 7 1,500.96 36 5 8 1,074.64 036 6 9
Combination Monthly Premiums(Continued)
Subscriber in B, Subscriber in B,
&1 Dependent in Plan Party Party Subscriber in B,&2+ Plan Party Party 1 Dependent in M,& Plan Party Party
Plan M Code Code Rate Dependents in M Code Code Rate 1+Dependent in B Code Code Rate
Anthem Blue Cross Del Norte and Medicare
Supplement $1,438.95 021 7 10 $1,820.89 21 8 11 $2,073.16 021 9 12
Anthem Blue Cross Select and Medicare
Preferred 1,376.00 457 7 10 1,736.19 457 8 11 1,985.49 457 9 12
Anthem Blue Cross Select and Medicare
Preferred with Dental/Vision' 1,376.00 460 7 10 1,736.19 460 8 11 1,985.49 460 9 12
Anthem Blue Cross Traditional HMO and
Medicare Preferred 1,664.19 518 7 10 2,024.38 518 8 11 2,446.59 518 9 12
Anthem Blue Cross Traditional HMO and
Medicare Preferred Dental/Vision' 1,664.19 521 7 10 2,024.38 521 8 11 2,446.59 521 9 12
Blue Shield Access+and Medicare 1,469.12 049 7 10 1,822.23 49 8 11 2,138.73 049 9 12
Blue Shield Access+and Medicare with
Dental/Vision2 1,469.12 089 7 101 1,822.23 1 891 81 ill 2,138.73 0891 91 12
2
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 45 of 51
Page 8 of 11
Updated:September 14,2021
CalPERS 2022 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1,2022
Alameda,Alpine,Amador,Butte,Calaveras,Colusa,Contra Costa,Del Norte,El 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(Continued)
Subscriber in B, Subscriber in B,
&1 Dependent in Plan Party Party Subscriber in B,&2+ Plan Party Party 1 Dependent in M,& Plan Party Party
Plan M Code Code Rate Dependents in M Code Code Rate 1+Dependent in B Code Code Rate
Blue Shield Access+EPO and Medicare $1,469.12 092 7 10 $1,822.23 092 8 11 $2,138.73 092 9 12
Blue Shield Access+EPO and Medicare with
Dental/Vision' 1,469.12 093 7 10 1,822.23 093 8 11 2,138.73 093 9 12
Blue Shield Trio and Medicare 1,251.65 094 71 10 1,604.76 094 81 11 1,790.77 094 9 12
Blue Shield Trio and Medicare with
Dental/Vision4 1,251.65 097 7 10 1,604.76 097 8 11 1,790.77 097 9 12
Kaiser Permanente and Senior Advantage 1,159.59 539 7 10 1,462.12 539 8 11 1,673.83 539 9 12
Kaiser Permanente and Senior Advantage
with Dental' 1,159.59 545 7 10 1,462.12 545 8 11 1,673.83 545 9 12
PERS Gold and Medicare Supplement 1,078.64 619 7 10 1,456.05 619 8 11 1,499.38 619 9 12
PERS Platinum and Medicare Supplement 1,438.95 609 7 10 1,820.89 609 8 11 2,073.16 609 9 12
Peace Officers Research Assoc of CA and
Medicare Supplement 1,308.00 598 7 10 1,825.00 598 8 11 1,782.00 598 9 12
UnitedHealthcare SignatureValue Alliance
and Medicare Advantage Edge 1,367.49 627 7 10 1,714.70 627 8 11 1,979.66 627 9 12
UnitedHealthcare SignatureValue Alliance
and Medicare Advantage 1,314.93 582 7 10 1,609.58 582 8 11 1,927.10 582 9 12
UnitedHealthcare SignatureValue Alliance
and Medicare Advantage with Dental/Vision' 1,314.93 588 7 10 1,609.58 588 8 11 1,927.10 5881 91 12
Western Health Advantage and Medicare
Advantage 1,056.20 036 7 10 1,371.14 036 8 11 1,500.96 1 036 9 12
'Dental and Vision coverage is an additional$38.00 per member per month premium.You will be billed directly for this amount.
Dental and Vision coverage is an additional$38.00 per member per month premium.You will be billed directly for this amount.
SDental and Vision coverage is an additional$38.00 per member per month premium.You will be billed directly for this amount.
°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.
SDental and Vision coverage is an additional$25.55 per member per month premium.You will be billed directly for this amount.
3
September 6, 2022 Regular ADMIN Committee Meeting Agenda Packet- Page 46 of 51
Attachment 3
CalPERS 2023 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2023
76AIa6Lm.l., pine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, EI Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa,
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
Plan Party Party Subscriber& Plan Party Party Subscriber& Plan Party Party
Plan Subscriber Code Code Rate 1 Dependent Code Code Rate 2+ Dependents Code Code Rate
Anthem Blue Cross Del Norte EPO $1,200.12 504 1 1 $2,400.24 504 2 2 $3,120.31 504 3 3
Anthem Blue Cross Select HMO 1,128.83 506 1 1 2,257.66 506 2 2 2,934.96 506 3 3
Anthem Blue Cross Traditional HMO 1,210.71 509 1 1 2,421 .42 509 2 2 3,147.85 509 3 3
Blue Shield Access+ HMO 1,035.21 525 1 1 2,070.42 525 2 2 2,691.55 525 3 3
Blue Shield Access+ EPO 1,035.21 524 1 1 2,070.42 524 2 2 2,691.55 524 3 3
Blue Shield Trio HMO* 888.94 451 1 1 1,777.88 451 2 2 2,311.24 451 3 3
Health Net SmartCare 1,174.50 528 1 1 2,349.00 528 2 2 3,053.70 528 3 3
Kaiser Permanente 913.74 533 1 1 1,827.48 533 2 2 2,375.72 533 3 3
Peace Officers Research Assoc of CA 825.00 592 1 1 1,875.00 592 21 2 2,300.00 592 3 3
PERS Gold 825.61 613 1 1 1,651 .22 613 2 2 2,146.59 613 3 3
PERS Platinum 1,200.12 601 1 1 2,400.24 601 2 2 3,120.31 601 3 3
UnitedHealthcare SignatureValue Alliance 11,044.07 576 1 1 2,088.14 576 2 2 2,714.58 576 3 3
Western Health Advantage HMO 760.17 591 1 11 1,520.341 591 2 21 1 ,976.441 5911 31 3
Plan Party Party Subscriber& Plan Party Party Subscriber& Plan Party Party
Plan Subscriber Code Code Rate 1 "�111 Code Code Rate 2+ Dependents Code Code Rate
Anthem Medicare Preferred PPO $413.59 515 1 4 $827.18 515 2 5 $1,240.77 515 3 6
Anthem Medicare Preferred PPO with
Dental/Vision' 413.59 512 1 4 827.18 512 2 5 1,240.77 512 3 6
Anthem Medicare Preferred PPO 413.59 455 1 4 827.18 455 2 5 1,240.77 455 3 6
Anthem Medicare Preferred PPO with Dental' 413.59 459 1 4 827.18 459 2 5 1,240.77 459 31 6
Blue Shield Medicare PPO 361.90 011 1 4 723.80 011 2 5 1,085.70 011 3 6
Blue Shield Medicare PPO with Dental/Vision2 361.90 016 1 4 723.80 016 2 5 1,085.70 016 3 6
Kaiser Permanente Senior Advantage 283.25 536 1 4 566.50 536 2 5 849.75 536 3 6
Kaiser Permanente Senior Advantage with
Dental3 283.25 542 1 4 566.50 542 2 5 849.75 542 3 6
Kaiser Permanente Senior Advantage Summit 336.29 630 1 4 672.58 630 2 5 1,008.87 630 3 6
Kaiser Permanente Senior Advantage Summit
with Denta13 336.29 636 1 4 672.58 636 2 5 1,008.87 636 3 6
Peace Officers Research Assoc of CA Medicare 465.00 595 1 4 1 ,030.00 595 2 5 1,395.00 595 3 6
Supplement
PERS Gold Medicare Supplement 392.71 616 1 4 785.42 616 2 5 1,178.13 616 3 6
PERS Platinum Medicare Supplement 420.02 605 1 4 840.04 605 2 5 1,260.06 605 3 6
UnitedHealthcare Group Medicare Advantage 299.68 579 1 4 599.36 579 2 5 899.04 579 3 6
PPO
UnitedHealthcare Group Medicare Advantage 357.70 476 1 4 715.40 476 2 5 1,073.10 476 3 6
Edge PPO
UnitedHealthcare Group Medicare Advantage 299 68 585 1 4 599.36 585 2 5 899.04 585 3 6
PPO with Dental/Vision4
Western Health Advantage MyCare Select HMO 331.11 035 1 4 662.22 035 2 5 993.33 035 3 6
*Blue Shield Trio is only available in Butte (pending DMHC approval), El Dorado, Monterey, Nevada, Placer, Sacramento, Santa Cruz, Stanislaus, and Yolo (partial counties served).
'Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
2Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
3Dental benefit is an additional $15.35 per member per month premium. You will be billed directly for this amount.
4Dental and Vision coverage is an additional $26.03 per member per month premium. You will be billed directly for this amount.
1
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CalPERS 2023 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2023
76AIa6Lm.l., pine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, EI Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa,
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
Subscriber in M,
Subscriber in M, & Plan Party Party Subscriber in M, & Plan Party Party 1 Dependent in M, & Plan Party Party
Plan 1 Dependent in B Code Code Rate 2+ Dependents in B Code Code Rate 1+ Dependent in B Code Code Rate
Anthem Blue Cross Del Norte EPO and
Medicare Supplement $1,620.14 021 4 7 $2,340.21 021 5 8 $1,560.11 021 6 9
Anthem Blue Cross Select HMO and Medicare 1,542.42 457 4 7 2,219.72 457 5 8 1,504.48 457 6 9
Preferred
Anthem Blue Cross Select HMO and Medicare
1,542.42 460 4 7 2,219.72 460 5 8 1,504.48 460 6 9
Preferred with Dental/Vision'
Anthem Blue Cross Traditional HMO and 1,624.30 518 4 7 2,350.73 518 5 8 1,553.61 518 6 9
Medicare Preferred
Anthem Blue Cross Traditional HMO and
1,624.30 521 4 7 2,350.73 521 5 8 1,553.61 521 6 9
Medicare Preferred with Dental/Vision'
Blue Shield Access+ HMO and Medicare 1,397.11 049 4 7 2,018.24 049 5 8 1,344.93 049 6 9
Blue Shield Access+ HMO and Medicare with
Dental/Vision2 1,397.11 089 4 7 2,018.24 089 5 8 1,344.93 089 6 9
Blue Shield Access+ EPO and Medicare 1,397.11 092 4 7 2,018.24 092 5 8 1,344.93 092 6 9
Blue Shield Access+ EPO and Medicare with
Dental/Vision3 1,397.11 093 4 7 2,018.24 093 5 8 1,344.93 093 6 9
Blue Shield Trio HMO and Medicare 1,250.84 094 4 7 1 ,784.20 094 5 8 1,257.16 094 6 9
Blue Shield Trio HMO and Medicare with Pact a02q 11
Dental/Vision4 1,250.84 097 4 7 1 ,7 �+ U 097 5 8 1,257.16 097 6 9
Kaiser Permanente and Senior Advantage 1,196.99 539 4 7 1 ,745.23 539 5 8 1,114.74 539 6 9
Kaiser Permanente and Senior Advantage with
Dental5 1,196.99 545 4 7 1,745.23 545 5 8 1 ,114.74 545 6 9
Kaiser Permanente and Senior Advantage 1,250.03 633 4 7 1 ,798.27 633 5 8 1,220.82 633 6 9
Summit
Kaiser Permanente and Senior Advantage
Summit with Dental5 1,250.03 639 4 7 1,798.27 639 5 8 1 ,220.82 639 6 9
Peace Officers Research Assoc of CA and 1,525.00 598 4 7 1 ,999.00 598 5 8 1,582.00 598 6 9
Medicare Supplement
PERS Gold and Medicare Supplement 1,218.32 619 4 7 1 ,713.69 619 5 8 1,280.79 619 6 9
PERS Platinum and Medicare Supplement 1,620.14 609 4 7 2,340.21 609 5 8 1,560.11 609 6 9
UnitedHealthcare SignatureValue Alliance and 1,343.75 582 4 7 1 ,970.19 582 5 8 1,225.80 582 6 9
Group Medicare Advantage PPO
UnitedHealthcare SignatureValue Alliance and 1,401.77 627 4 7 2,028.21 627 5 8 1,341 .84 627 6 9
Group Medicare Advantage Edge PPO
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage PPO with 1,343.75 588 4 7 1,970.19 588 5 8 1 ,225.80 588 6 9
Dental/Visions
Western Health Advantage HMO and MyCare 1,091.28 036 4 7 1 ,547.38 036 5 8 1,118.32 036 6 9
Select HMO
'Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
2Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
3Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
4Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
SDental benefit is an additional $15.35 per member per month premium. You will be billed directly for this amount.
6Dental and Vision coverage is an additional $26.03 per member per month premium. You will be billed directly for this amount.
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CalPERS 2023 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2023
76AIa6Lm.l., pine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, EI Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa,
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
Subscriber in B,
Subscriber in B, & Plan Party Party Subscriber in B, & Plan Party Party 1 Dependent in M, & Plan Party Party
Plan 1 Dependent in M Code Code Rate 2+ Dependents in M Code Code Rate 1+ Dependent in B Code Code Rate
Anthem Blue Cross Del Norte EPO and
Medicare Supplement $1,620.14 021 7 10 $2,040.16 021 8 11 $2,340.21 021 9 12
Anthem Blue Cross Select HMO and Medicare 1,542.42 457 7 10 1 ,956.01 457 8 11 2,219.72 457 9 12
Preferred
Anthem Blue Cross Select HMO and Medicare
1,542.42 460 7 10 1 ,956.01 460 8 11 2,219.72 460 9 12
Preferred with Dental/Vision'
Anthem Blue Cross Traditional HMO and 1,624.30 518 7 10 2,037.89 518 8 11 2,350.73 518 9 12
Medicare Preferred
Anthem Blue Cross Traditional HMO and
1,624.30 521 7 10 2,037.89 521 8 11 2,350.73 521 9 12
Medicare Preferred with Dental/Vision
Blue Shield Access+ HMO and Medicare 1,397.11 049 7 10 1 ,759.01 049 8 11 2,018.24 049 9 12
Blue Shield Access+ HMO and Medicare with
Dental/Vision2 1,397.11 089 7 10 1 ,759.01 089 8 11 2,018.24 089 9 12
Blue Shield Access+ EPO and Medicare 1,397.11 092 7 10 1 ,759.01 092 8 11 2,018.24 092 9 12
Blue Shield Access+ EPO and Medicare with
Dental/Vision3 1,397.11 093 7 10 1 ,759.01 093 8 11 2,018.24 093 9 12
Blue Shield Trio HMO and Medicare 1,250.84 094 7 10 1 ,612.74 094 8 11 1,784.20 094 9 12
Blue Shield Trio HMO and Medicare with Pa e 1 11
Dental/Vision4 1,250.84 097 7 10 1, 1 .7° 097 8 11 1 ,784.20 097 9 12
Kaiser Permanente and Senior Advantage 1,196.99 539 7 10 1 ,480.24 539 8 11 1,745.23 539 9 12
Kaiser Permanente and Senior Advantage with 1,196.99 545 7 10 1 ,480.24 545 8 11 1,745.23 545 9 12
Dental5
Kaiser Permanente and Senior Advantage 1,250.03 633 7 10 1 ,586.32 633 8 11 1,798.27 633 9 12
Summit
Kaiser Permanente and Senior Advantage
Summit with Dental5 1,250.03 639 7 10 1 ,586.32 639 8 11 1,798.27 639 9 12
Peace Officers Research Assoc of CA and 1,392.00 598 7 10 1 ,854.00 598 8 11 1,868.00 598 9 12
Medicare Supplement
PERS Gold and Medicare Supplement 1,218.32 619 7 10 1 ,611.03 619 8 11 1,713.69 619 9 12
PERS Platinum and Medicare Supplement 1,620.14 609 7 101 2,040.16 609 8 111 2,340.21 609 9 12
UnitedHealthcare SignatureValue Alliance and 1,343.75 582 7 10 1,643.43 582 8 11 1 ,970.19 582 9 12
Group Medicare Advantage PPO
UnitedHealthcare SignatureValue Alliance and 1,401.77 627 7 10 1 ,759.47 627 8 11 2,028.21 627 9 12
Group Medicare Advantage Edge PPO
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage PPO with 1,343.75 588 7 10 1,643.43 588 8 11 1 ,970.19 588 9 12
Dental/Visions
Western Health Advantage HMO and MyCare 1,091.28 036 7 10 1,422.39 036 8 11 1 ,547.38 036 9 12
Select HMO
'Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
2Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
3Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
4Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
5Dental benefit is an additional $15.35 per member per month premium. You will be billed directly for this amount.
6Dental and Vision coverage is an additional $26.03 per member per month premium. You will be billed directly for this amount.
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