MEDICAL PLANS FOR RETIREES AND DEPENDENTS WHO ARE UNDER AGE 65 AND NOT ELIGIBLE FOR MEDICARE*

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1 Cost of Coverage MONTHLY PLAN COSTS FOR EARLY RETIREES The following costs are the total costs for premiums prior to the County contribution. Refer to the County contributions chart on page 48 to determine how much the County will contribute toward your medical coverage, and deduct it from the monthly cost listed below. MEDICAL PLANS FOR RETIREES AND DEPENDENTS WHO ARE UNDER AGE 65 AND NOT ELIGIBLE FOR MEDICARE* Exclusive Care EPO 2017 Rate 2018 Rate Variance Retiree only $ $ $73.29 Retiree plus one dependent $1, $1, $ Retiree plus family $2, $2, $ UnitedHealthcare HMO Retiree only $1, $1, $ Retiree plus one dependent $2, $2, $ Retiree plus family $2, $3, $ Kaiser Permanente HMO Retiree only $ $ $ Retiree plus one dependent $1, $1, $ Retiree plus family $2, $2, $ UnitedHealthcare PPO Retiree only $1, $2, $ Retiree plus one dependent $3, $3, $ Retiree plus family $4, $5, $ * If you or your dependents are OVER age 65 and you are NOT eligible for Medicare, please contact the Benefits Information Line for assistance calculating your rate COR Benefits Guide 47

2 COST OF COVERAGE MONTHLY COUNTY CONTRIBUTIONS When you enroll in a County-sponsored medical plan, either when you retire or during a subsequent Annual Enrollment, the County will make a monthly contribution toward your medical plan premiums. The amount of the contribution is based on the bargaining unit you were in at the time of your retirement. The contributions are as follows: Bargaining Unit at Retirement County Contribution if You Retired Before 11/1/05 County Contribution if You Retired On or After 11/1/05 Confidential DDAA (Prosecution) Elected Officials LEMU LIUNA Management SEIU Unrepresented RSA Public Safety COR Benefits Guide

3 MONTHLY COSTS FOR MEDICARE-ELIGIBLE RETIREES Medical Plans for MEDICARE-ELIGIBLE Retirees Exclusive Care Select Medicare Coordination Plan and Combination Rates Retiree only, 65 and over with Medicare Parts A and B $ $ $82.63 Retiree plus one dependent, one over 65 with Medicare Parts A and B Retiree plus one dependent, both over 65 with Medicare Parts A and B Exclusive Care Supplement Plan and Combination Rates $1, $1, $ $1, $1, $ Retiree only $ $ $41.51 Retiree and spouse, one with Medicare $1, $1, $ Retiree and spouse, both with Medicare $ $ $81.80 Note: Participants who are under age 65 and are not eligible for Medicare will be enrolled in the Exclusive Care EPO plan. Participants must live within the plan s service area. Medical Plans for MEDICARE-ELIGIBLE Retirees UnitedHealthcare Medicare Advantage HMO Retiree only $ $ $82.44 Retiree and spouse (retiree with Medicare) $1, $1, $ Retiree and spouse, both with Medicare $ $ $ UnitedHealthcare Medicare EPO COB Retiree only $ $ $ Retiree and spouse (retiree with Medicare) $1, $2, $ Retiree and spouse, both with Medicare $1, $1, $ UnitedHealthcare Medicare PPO COB Retiree only $1, $1, $ Retiree plus one (both with Medicare) $2, $2, $ UnitedHealthcare Medicare Indemnity COB Retiree only $1, $1, $ Retiree plus one (both with Medicare) $2, $2, $ SCAN HMO Retiree only $ $ $23.00 Retiree plus one dependent (both with Medicare Parts A and B) Note: You and your dependent must be eligible for Medicare to enroll in this plan. $ $ $44.97 Note: If you or your dependents are OVER age 65 and you are NOT eligible for Medicare, please contact the Benefits Information Line for assistance. The rates listed are the most frequently used rates. If your specific Medicare status is not listed above or if you are not sure what your rate will be, please call the Benefits Information Line at (951) We ll be happy to assist you. If retiree is non-medicare and spouse is Medicare, rates may be up to $2.00 higher COR Benefits Guide 49

4 MONTHLY COSTS FOR MEDICARE-ELIGIBLE RETIREES Kaiser Senior Advantage* Original Plan Retiree only, with Medicare Parts A and B $ $ $15.09 Retiree and spouse (retiree with Medicare) $1, $1, $ Retiree and spouse (spouse with Medicare Parts A and B) $1, $1, $ Retiree and spouse (both with Medicare Parts A and B) $ $ $28.93 Retiree with Medicare Parts A and B, spouse and dependent without Medicare Retiree and spouse with Medicare Parts A and B, dependent without Medicare $1, $1, $ $1, $1, $ Note: If you or your dependents are OVER age 65 and you are NOT eligible for Medicare, please contact the Benefits Information Line for assistance. The rates listed are the most frequently used rates. If your specific Medicare status is not listed above or if you are not sure what your rate will be, please call the Benefits Information Line at (951) We ll be happy to assist you. If retiree is non-medicare and spouse is Medicare, rates may be up to $2.00 higher. Kaiser Senior Advantage Low Plan 2017 Monthly 2018 Monthly Monthly Variance Retiree only, with Medicare Parts A and B $ $ $15.20 Retiree and spouse (retiree with Medicare) $1, $1, $ Retiree and spouse (spouse with Medicare Parts A and B) $1, $1, $ Retiree and spouse (both with Medicare Parts A and B) $ $ $29.15 Retiree with Medicare Parts A and B, spouse and dependent without Medicare $1, $1, $ Retiree and spouse with Medicare Parts A and B, dependent without Medicare $ $ $ MONTHLY COSTS FOR DENTAL AND VISION COVERAGE County Dental Plans Local Advantage Plus (EPO) 2017 Monthly 2018 Monthly Monthly Variance Retiree only $40.14 $40.14 $0 Retiree plus one dependent $77.92 $77.92 $0 Retiree plus family $ $ $0 Local Advantage Blythe (EPO) Retiree only $29.22 $29.22 $0 Retiree plus one dependent $51.26 $51.26 $0 Retiree plus family $77.46 $77.46 $0 DeltaCare USA DHMO High Option Plan (10A) Retiree only $22.84 $22.84 $0 Retiree plus one dependent $33.80 $33.80 $0 Retiree plus family $52.00 $52.00 $0 Delta Dental (PPO) Retiree only $43.58 $43.58 $0 Retiree plus one dependent $78.02 $78.02 $0 Retiree plus family $ $ $0 County Vision Plan MES Vision Retiree only $10.98 $10.98 $0 Retiree plus one dependent $21.04 $21.04 $0 Retiree plus family $27.92 $27.92 $ COR Benefits Guide

5 CONTACT INFORMATION Contact Information CONTACT INFORMATION Plan Telephone Website Medical UnitedHealthcare HMO (Early Retiree) (800) UnitedHealthcare PPO (Early retiree) (866) UnitedHealthcare Group EPO, PPO, Indemnity COB (866) UnitedHealthcare Group Medicare Advantage Pre-Enrollment Customer Service (877) Post-Enrollment Customer Service (800) Exclusive Care (EPO) (800) Exclusive Care Select Medicare Supplement and Medicare Coordination Plans (800) Kaiser Permanente (HMO) (800) SCAN (HMO) (800) Dental DeltaCare USA (HMO) (800) Delta Dental (PPO) (800) Local Advantage Plus (800) Vision MES Vision (800) Other Benefits and County Resources County of Riverside Benefits Division Benefits Information Line P.O. Box 1569 Riverside, CA CalPERS Health Benefits Services Division Eligibility and Enrollment Section P.O. Box Sacramento, CA (951) TTY: (951) Fax: (951) Mon. Fri. 8:00 a.m. 5:00 p.m. (888) Voluntary Employee Beneficiary Association (VEBA) (800) Medicare Information Centers for Medicare & Medicaid Services (CMS) (800) TTY: (877) Social Security Administration (800) TTY: (800) Advocacy Services (888) or (951) , option 3 see the publication Medicare & You located at the bottom of the page COR Benefits Guide 51