Teammate Open Enrollment 2021

CalPERS Region 1 Health Plan Rates Available for 2021 - AFSCME

Delta Dental PPO

Employee Pays per month

2021 City Contribution

Total Premium

Medical

$ 40.00

$290.00

Medical in-lieu

$

250.00

Anthem Blue Cross Select HMO Employee

$

925.60

$ $ $

60.89

$

986.49

$ $ $

784.00

$

202.49

Employee +1

1,851.20 $ 2,406.56 $

101.37 160.01

1,952.57 $ 2,566.57 $

1,568.00 2,055.00

$

384.57

Family

$

511.57

Anthem Blue Cross Traditional HMO Employee

1,307.86 $ 2,615.72 $ 3,400.44 $

$ $ $

60.89

1,368.75 $ 2,717.09 $ 3,560.45 $

$ $ $

784.00

$

584.75

Employee +1

101.37 160.01

1,568.00 2,055.00

$

1,149.09

Family

$

1,505.45

-

HealthNet SmartCare Employee

1,120.21 $ 2,240.42 $ 2,912.55 $

$ $ $

60.89

1,181.10 $ 2,341.79 $ 3,072.56 $

$ $ $

784.00

$

397.10

Employee +1

101.37 160.01

1,568.00 2,055.00

$

773.79

Family

$

1,017.56

Kaiser Permanente

Employee

$

813.64

$ $ $

60.89

$

874.53

$ $ $

784.00

$

90.53

Employee +1

1,627.28 $ 2,115.46 $

101.37 160.01

1,728.65 $ 2,275.47 $

1,568.00 2,055.00

$

160.65

Family

$

220.47

Western Health Advantage Employee

$

757.02

$ $ $

60.89

$

817.91

$ $ $

784.00

$

33.91

Employee +1

1,514.04 $ 1,968.25 $

101.37 160.01

1,615.41 $ 2,128.26 $

1,568.00 2,055.00

$

47.41

Family

$

73.26

PERS Care PPO

Employee

1,294.69 $ 2,589.38 $ 3,366.19 $

$ $ $

60.89

1,355.58 $ 2,690.75 $ 3,526.20 $

$ $ $

784.00

$

571.58

Employee +1

101.37 160.01

1,568.00 2,055.00

$

1,122.75

Family

$

1,471.20

PERS Choice PPO

Employee

$

935.84

$ $ $

60.89

$

996.73

$ $ $

784.00

$

212.73

Employee +1

1,871.68 $ 2,433.18 $

101.37 160.01

1,973.05 $ 2,593.19 $

1,568.00 2,055.00

$

405.05

Family

$

538.19

PERS Select PPO

Employee

$

566.67

$ $ $

60.89

$

627.56

$ $ $

784.00

$

-

Employee +1

1,133.34 $ 1,473.34 $

101.37 160.01

1,234.71 $ 1,633.35 $

1,568.00 2,055.00

$

-

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 $ EyeMed Employee

$ $ $

? ? ?

10.92 20.76 30.45

Employee +1

$ $

101.37 160.01

Employee +1

Family

Family