LOCAL 21 CLASSIFIED SALARIED EMPLOYEES Twelve (12) Month Employees. Plans EE EE+1 FAM EE EE+1 FAM
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1 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES Twelve (12) Month s CalPERS Premium Rates CalPERS Premium Rates Bay Area Region Bay Area Region 12 Month 10 Month Plans EE EE FAM EE EE FAM Kaiser $ $1, $2, $ $1, $2, Anthem HMO Select $ $1, $2, $1, $2, $2, Anthem HMO Traditional $ $1, $2, $1, $2, $2, Blue Shield Access+ $ $1, $2, $1, $2, $2, Health Net SmartCare $ $1, $2, $1, $2, $2, United Healthcare $1, $2, $3, $1, $3, $4, Western Health Advantage $ $1, $2, $ $1, $2, PERS Choice $80 $1, $2,08 $ $1, $2, PERS Select $ $1, $1, $86 $1, $2, PERS Care $ $1, $2, $1, $2, $2, Cash In Lieu $ $ DELTA DENTAL PPO $ $ $ $ $ $ DELTACARE DHMO $32.21 $32.21 $32.21 $38.65 $38.65 $38.65 VSP $8.98 $17.96 $28.93 $10.78 $21.55 $34.72 ` District : 12 Month District : 10 Month Medical $ $ $1, $ $1, $1, Dental DHMO $66.15 $79.38 PPO $66.15 $79.38 Effective January 1, 2018 AS OF UPDATED 8/16/2017
2 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES Twelve (12) Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY Cash In Lieu of Kaiser Anthem HMO Select Anthem HMO Traditional Blue Shield Access+ HMO Benefits Ten Month Rate $ $ $ $ % of Kaiser = + 1 $1, $1, $1, $1, $ $2, $2, $2, $2, Paid to per month $ $ $1, $ $ $1, $ $ $1, $ $ $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $20.78 $ $1, $1, $ $1, $2, $87 $1, $2, $ $1, $2, $41.61 $ $1, $1, $ $1,62 $2, $ $1, $2, $ $1, $2, $62.39 $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $83.16 $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $1,93 $ $1, $2, $ $1, $2, $ $53 $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1,48 $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $27 $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1,72 $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $ $1, $ $1, $1, $ $1, $1, $ $1,16 $1, $ $ $ $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $ $ $ $ $25.79 $ $1, $94.85 $ $1, $58.40 $ $1, $623.89
3 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES Twelve (12) Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY Health Net SmartCare HMO United Healthcare HMO Western Health Advantage HMO + 1 $ $1, $ $1, $2, $1, $2, $3, $2, /more $ $ $1, $ $ $1, $ $ $1, $ $1, $2, $1, $2, $3, $ $1, $2, $ $1, $2, $1, $2, $3, $ $1, $2, $ $1, $2, $1, $2, $3, $ $1, $1, $ $1, $2, $1, $2, $3, $ $1, $1, $ $1, $2, $1, $2, $3, $ $1, $1, $ $1, $2,06 $1, $2, $3, $ $1, $1, $ $1, $2, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1,48 $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1,58 $ $1, $1, $ $2, $3, $ $1, $1, $ $1, $1,69 $ $2, $3, $ $1, $1, $ $1, $1, $ $2, $2, $ $1, $1, $ $1, $1, $ $2, $2, $ $1, $1, $ $1, $1, $ $2, $2, $ $1, $1, $ $1, $1, $ $2, $2, $ $ $1, $ $1, $1, $ $2, $2, $ $ $1, $ $1, $1, $ $2, $2, $ $ $1,284.43
4 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES Twelve (12) Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY PERS Choice PERS Select PERS Care + 1 $80 $ $ $1, $1, $1, $2,08 $1, $2, $ $ $1, $ $ $1, $ $ $1, $80 $1, $2,08 $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1,23 $1, $ $1, $1, $55 $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1, $ $ $1, $ $ $1, $ $1, $1, $ $ $1, $ $ $1, $ $1, $1,518.14
5 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES Twelve (12) Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY + 1 DELTA DENTAL VSP (Vision Plan) DeltaCare PPO (100% Contribution) DHMO $32.21 $ $8.98 $32.21 $ $17.96 $32.21 $ $28.93 or Family or Family $66.15 $66.15 $ $ $ $32.21 $ $8.98 $17.96 $28.93 $30.01 $ $8.98 $17.96 $28.93 $27.80 $ $8.98 $17.96 $28.93 $25.60 $98.25 $8.98 $17.96 $28.93 $23.39 $96.04 $8.98 $17.96 $28.93 $21.18 $93.83 $8.98 $17.96 $28.93 $18.98 $91.63 $8.98 $17.96 $28.93 $16.78 $89.43 $8.98 $17.96 $28.93 $14.57 $87.22 $8.98 $17.96 $28.93 $12.37 $85.02 $8.98 $17.96 $28.93 $10.16 $82.81 $8.98 $17.96 $28.93 $7.95 $8 $8.98 $17.96 $28.93 $5.75 $78.40 $8.98 $17.96 $28.93 $3.55 $76.20 $8.98 $17.96 $28.93 $1.34 $73.99 $8.98 $17.96 $28.93 $ $71.79 $8.98 $17.96 $28.93 $ $69.58 $8.98 $17.96 $28.93 $ $67.37 $8.98 $17.96 $28.93 $ $65.17 $8.98 $17.96 $28.93 $ $62.97 $8.98 $17.96 $28.93 $ $60.76 $8.98 $17.96 $28.93 $ $58.56 $8.98 $17.96 $28.93
6 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES TEN Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY Kaiser Anthem HMO Select Anthem HMO Traditional Blue Shield Access+ HMO Cash In Lieu of Benefits (paid 10 months) $ $1, $1, $1, % of Kaiser = + 1 $1, $2, $2, $2, $ $2, $2, $2, $2, Paid to per month $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $2, $1, $2, $2, $1, $2, $2, $1, $2, $2, $ $ $1, $2, $ $2, $2, $1, $2, $2, $1, $2, $2, $24.93 $ $1, $2, $ $1, $2, $1, $2, $2, $1, $2, $2, $49.94 $ $1, $2,30 $ $1, $2, $1, $2, $2, $ $2, $2,64 $74.87 $ $1, $2, $ $1, $2, $ $2, $2, $ $1, $2, $99.80 $ $1, $2, $ $1,87 $2, $ $2, $2, $90 $1, $2, $ $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $67 $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $57 $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1,90 $ $1,61 $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $2, $ $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $ $1, $1, $ $1, $1, $ $1, $2, $ $1,43 $1, $ $ $1, $1, $ $1, $1, $ $1,48 $2,00 $ $1, $1, $ $ $1, $1, $ $1, $1,74 $ $1, $1, $ $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $ $ $76 $1, $30.95 $ $1, $ $1,11 $1, $70.08 $1, $1, $748.67
7 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES TEN Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY Health Net SmartCare HMO United Healthcare HMO Western Health Advantage HMO + 1 $1, $1, $ $2, $3, $1, $2, $4, $2, /more $ $1, $1, $ $1, $1, $ $1, $1, $1, $2, $2, $1, $3, $4, $ $1, $2, $1, $2, $2, $1, $3, $4, $ $1, $2, $ $1, $2, $1, $3, $4, $ $1, $2, $ $1, $2, $1, $3, $4, $ $1, $2, $ $1, $2, $1, $3, $4, $ $1, $2, $ $1, $2, $1, $3, $4, $ $1, $2, $ $1, $2, $1, $3, $4, $ $1, $2, $ $1, $2, $1, $3, $3, $ $1, $2, $ $1, $2, $1, $2, $3, $ $1, $2, $ $1, $2, $1, $2, $3,88 $ $1, $2, $ $1, $2, $1, $2, $3, $ $1, $2, $67 $1, $2, $1,28 $2, $3, $ $1, $2, $ $1, $2, $1, $2, $3, $ $1, $2, $ $1, $2, $1, $2, $3, $ $1,42 $1, $57 $1, $2, $1, $2, $3, $ $1, $1, $ $1, $2, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $1, $2, $3, $ $1, $1, $ $1, $1, $ $2, $3, $ $1, $1, $ $1, $1, $ $2, $3, $ $1, $1,695.07
8 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES TEN Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY PERS Choice PERS Select PERS Care + 1 $ $86 $1, $1, $1, $2, $2, $2, $2, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $2, $86 $1, $2, $1, $2, $2, $ $1, $2, $ $1, $2, $1, $2, $2, $ $1, $2, $ $1, $2, $ $2, $2, $ $1, $2, $ $1,61 $2, $ $2, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2, $ $1, $2,23 $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $ $1, $2, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $2,22 $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $56 $1, $2, $ $1, $1, $ $1, $1, $ $1, $2, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1, $ $1, $1, $ $ $1, $ $1, $1,821.77
9 LOCAL 21 CLASSIFIED SALARIED EMPLOYEES TEN Month s AMOUNT TO BE PAID WILL BE BASED ON ACTUAL. TABLES ARE ESTIMATES ONLY + 1 DELTA DENTAL VSP (Vision Plan) DeltaCare PPO (100% Contribution) DHMO $38.65 $ $10.78 $38.65 $ $21.55 $38.65 $ $34.72 or Family or Family $79.38 $79.38 $ $ $ $38.65 $ $10.78 $21.55 $34.72 $36.01 $ $10.78 $21.55 $34.72 $33.36 $ $10.78 $21.55 $34.72 $30.72 $ $10.78 $21.55 $34.72 $28.07 $ $10.78 $21.55 $34.72 $25.42 $ $10.78 $21.55 $34.72 $22.78 $ $10.78 $21.55 $34.72 $20.14 $ $10.78 $21.55 $34.72 $17.48 $ $10.78 $21.55 $34.72 $14.84 $ $10.78 $21.55 $34.72 $12.19 $99.36 $10.78 $21.55 $34.72 $9.54 $96.71 $10.78 $21.55 $34.72 $6.90 $94.08 $10.78 $21.55 $34.72 $4.26 $91.44 $10.78 $21.55 $34.72 $1.61 $88.79 $10.78 $21.55 $34.72 $ $86.15 $10.78 $21.55 $34.72 $ $83.50 $10.78 $21.55 $34.72 $ $80.85 $10.78 $21.55 $34.72 $ $78.20 $10.78 $21.55 $34.72 $ $75.57 $10.78 $21.55 $34.72 $ $72.91 $10.78 $21.55 $34.72 $ $7 $10.78 $21.55 $34.72
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