Teammate Open Enrollment 2021

CalPERS Region 1 Health Plan Rates Available for 2021 - CSOA

Delta Dental PPO

2021 City Contribution

Total Premium

Employee Pays Monthly

VSP

Medical

Medical in-lieu

$715.00

Anthem Blue Cross Select HMO Employee

$

925.60

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

60.89

18.39 $ 28.57 $ 45.31 $ 18.39 $ 28.57 $ 45.31 $ 18.39 $ 28.57 $ 45.31 $ 18.39 $ 28.57 $ 45.31 $ 18.39 $ 28.57 $ 45.31 $ 18.39 $ 28.57 $ 45.31 $ 18.39 $ 28.57 $ 45.31 $ 18.39 $ 28.57 $ 45.31 $

1,004.88 $ 1,981.14 $ 2,611.88 $ 1,387.14 $ 2,745.66 $ 3,605.76 $

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

800.00

$ $ $

204.88 280.87 502.65

Employee +1

1,851.20 $ 2,406.56 $

101.37 160.01

1,700.27 2,109.23

Family

Anthem Blue Cross Traditional HMO Employee

$

1,307.86

60.89

800.00

$ $ $

587.14

Employee +1

2,615.72 $ 3,400.44 $

101.37 160.01

1,700.27 2,109.23

1,045.39 1,496.53

Family

HealthNet SmartCare Employee

$

1,120.21

60.89

1,199.49 $ 2,370.36 $ 3,117.87 $

800.00

$ $ $

399.49 670.09

Employee +1

2,240.42 $ 2,912.55 $

101.37 160.01

1,700.27 2,109.23

Family

1,008.64

Kaiser Permanente

Employee

$

813.64

60.89

$

892.92

800.00

$ $ $

92.92 56.95

Employee +1

1,627.28 $ 2,115.46 $

101.37 160.01

1,757.22 $ 2,320.78 $

1,700.27 2,109.23

Family

211.55

Western Health Advantage Employee

$

757.02

60.89

$

836.30

800.00

$ $ $

36.30

Employee +1

1,514.04 $ 1,968.25 $

101.37 160.01

1,643.98 $ 2,173.57 $

1,700.27 2,109.23

(56.29)

Family

64.34

PERS Care PPO

Employee

$

1,294.69

60.89

1,373.97 $ 2,719.32 $ 3,571.51 $ 1,015.12 $ 2,001.62 $ 2,638.50 $

800.00

$ $ $

573.97

Employee +1

2,589.38 $ 3,366.19 $

101.37 160.01

1,700.27 2,109.23

1,019.05 1,462.28

Family

PERS Choice PPO

Employee

$

935.84

60.89

800.00

$ $ $

215.12 301.35 529.27

Employee +1

1,871.68 $ 2,433.18 $

101.37 160.01

1,700.27 2,109.23

Family

PERS Select PPO

Employee

$

566.67

60.89

$

645.95

800.00

$ $ $

(154.05) (436.99) (430.57)

Employee +1

1,133.34 $ 1,473.34 $

101.37 160.01

1,263.28 $ 1,678.66 $

1,700.27 2,109.23

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

Family