Teammate Handbook Cover

CalPERS Region 1 Health Plan Rates Available for 2023 - CSOA

Delta Dental PPO

*2022 City Contribution Employee Pays Monthly

Total Premium

VSP

Medical

Medical in-lieu

$715.00

Anthem Blue Cross Select HMO Employee

1,128.83 $ 2,257.66 $ 2,934.96 $ 1,210.71 $ 2,421.42 $ 3,147.85 $ 1,035.21 $ 2,070.42 $ 2,691.55 $ ,

$

60.89

$ 18.39 1,208.11 $ $ 28.57 2,387.60 $ $ 45.31 3,140.28 $ $ 18.39 1,289.99 $ $ 28.57 2,551.36 $ $ 45.31 3,353.17 $ $ 18.39 1,114.49 $ $ 28.57 2,200.36 $ $ 45.31 2,896.87 $

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

882.00

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

326.11 513.60 814.28

Employee +1

101.37 $ 160.01 $

1,874.00 2,326.00

Family

$ Anthem Blue Cross Traditional HMO Employee

$

60.89

882.00

407.99 677.36

Employee +1

101.37 $ 160.01 $

1,874.00 2,326.00

Family

1,027.17

Blue Shield Access + HMO Employee

$

60.89

882.00

232.49 326.36 570.87

1,874.00 2,326.00

101.37 $ 160.01 $

Employee +1

Family

Blue Shield Trio HMO

* See CalPERs Regional Health Premium

Employee

$

888.94

$

60.89

$ 18.39

$

968.22

882.00

86.22 33.82

$ 28.57 1,907.82 $ $ 45.31 2,516.56 $

1,874.00 2,326.00

101.37 $ 160.01 $

Employee +1

1,777.88 $ 2,311.24 $

Family

190.56

HealthNet SmartCare Employee

1,174.50 $ 2,349.00 $ 3,053.70 $

$

60.89

$ 18.39 1,253.78 $ $ 28.57 2,478.94 $ $ 45.31 3,259.02 $

882.00

371.78 604.94 933.02

Employee +1

101.37 $ 160.01 $

1,874.00 2,326.00

Family

Kaiser Permanente

Employee

$

913.74

$

60.89

$ 18.39

$

993.02

882.00

111.02

Employee +1

1,827.48 $ 2,375.72 $

101.37 $ 160.01 $

$ 28.57 1,957.42 $ $ 45.31 2,581.04 $

1,874.00 2,326.00

83.42

Family

255.04

PERS Gold (Select) PPO Employee

$

825.61

$

60.89

$ 18.39

$

904.89

882.00

22.89

Employee +1

1,651.22 $ 2,146.59 $

101.37 $ 160.01 $

$ 28.57 1,781.16 $ $ 45.31 2,351.91 $

1,874.00 2,326.00

(92.84)

Family

25.91

PERS Platinum PPO (Care and Choice) Employee

1,200.12 $ 2,400.24 $ 3,120.31 $

$

60.89

$ 18.39 1,279.40 $ $ 28.57 2,530.18 $ $ 45.31 3,325.63 $ $ 18.39 1,123.35 $ $ 28.57 2,218.08 $ $ 45.31 2,919.90 $

882.00

$ $ $

397.40 656.18 999.63

Employee +1

101.37 $ 160.01 $

1,874.00 2,326.00

Family

UnitedHealthcare SignatureValue Alliance Employee 1,044.07 $

$

60.89

882.00

$ $ $

241.35 344.08 593.90

Employee +1

2,088.14 $ 2,714.58 $

101.37 $ 160.01 $

1,874.00 2,326.00

Family

Western Health Advantage Employee

$

760.17

$

60.89

$ 18.39

$

839.45

882.00

$ $ $

(42.55) (223.72) (144.24)

Employee +1

1,520.34 $ 1,976.44 $

101.37 $ 160.01 $

$ 28.57 1,650.28 $ $ 45.31 2,181.76 $

1,874.00 2,326.00

Family

Health Plans and Rates listed are for Region 1 Pricing. Employees not living in Region 1 will have different rates Delta Dental Employee 60.89 $ VSP Employee

$ $

18.39 28.57 45.31

Employee +1

$ $

101.37 160.01

Employee +1

Family $ * City Contribution may change once the new MOU has been approved. Teammates will be notified as appropriate. Family