Human Resources Benefits Unit

Medical Premium Rates for Retirees without Medicare, $500 Contribution

premiumratesimageEffective Dates:

June 1, 2020 - May 31, 2021

Levels of Coverage

Retiree and Dependents - Non-Medicare

Self
Two-Party
Family

Retiree and Dependents - Split Enrollment in Medicare and Non-Medicare

1 Medicare + 1 Non-Medicare
1 Medicare + 2 or more Non-Medicare

Eligibility for County Contribution

Please note: Monthly county contribution is for eligible retiree only.

Level of Coverage: Self - Non-Medicare

Medical Plan Monthly Retiree Cost Monthly County ContributionMonthly Total Premium
County Health Plan EPO $600.96$500 $1,100.96
County Health Plan PPO $833.94$500 $1,333.94
Kaiser Permanente Traditional HMO $403.94$500 $903.94
Kaiser Permanente Hospital Services DHMO $227.84$500$727.84
Kaiser Permanente Deductible First HDHP $175.38$500 $675.38
Kaiser Northwest$555.97$500$1,055.97
Kaiser Hawaii$416.66$500$916.66
Sutter Health Plus HMO$174.38$500$674.38
Sutter Health Plus Hospital Services DHMO$78.62$500$578.62
Sutter Health Plus Deductible First HDHP$37.18$500$537.18
Western Health Advantage HMO$199.00$500$699.00
Western Health Advantage Hospital Services DHMO$79.44$500$579.44
Western Health Advantage Deductible First HDHP$25.48$500$525.48


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Level of Coverage:
Two-Party - Both Non-Medicare

Medical Plan Monthly Retiree CostMonthly County ContributionMonthly Total Premium
County Health Plan EPO $1,650.68$500 $2,150.68
County Health Plan PPO $2,122.12$500 $2,622.12
Kaiser Permanente Traditional HMO $1,307.88$500 $1,807.88
Kaiser Permanente Hospital Services DHMO $955.68$500 $1,455.68
Kaiser Permanente Deductible First HDHP $850.76$500 $1,350.76
Kaiser Northwest$1,611.94$500$2,111.94
Kaiser Hawaii$1,333.32$500$1,833.32
Sutter Health Plus HMO$848.86$500$1,348.86
Sutter Health Plus Hospital Services DHMO$657.30$500$1,157.30
Sutter Health Plus Deductible First HDHP$573.98$500$1,073.98
Western Health Advantage HMO$898.00$500$1,398.00
Western Health Advantage Hospital Services DHMO$658.92$500$1,158.92
Western Health Advantage Deductible First HDHP$551.00$500$1,051.00


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Level of Coverage:
Family - All Non-Medicare

Medical Plan Monthly Retiree CostMonthly County ContributionMonthly Total Premium
County Health Plan EPO $2,499.92$500 $2,999.92
County Health Plan PPO $3,164.26$500 $3,664.26
Kaiser Permanente Traditional HMO $2,058.16$500 $2,558.16
Kaiser Permanente Hospital Services DHMO $1,559.78$500 $2,059.78
Kaiser Permanente Deductible First HDHP $1,411.32$500 $1,911.32
Kaiser Northwest$2,667.92$500$3,167.92
Kaiser Hawaii$2,249.98$500$2,749.98
Sutter Health Plus HMO$1,408.82$500$1,908.82
Sutter Health Plus Hospital Services DHMO$1,137.70$500$1,637.70
Sutter Health Plus Deductible First HDHP$1,020.46$500$1,520.46
Western Health Advantage HMO$1,478.16$500$1,978.16
Western Health Advantage Hospital Services DHMO$1,139.88$500$1,639.88
Western Health Advantage Deductible First HDHP$987.18$500$1,487.18


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Level of Coverage:
1 Medicare + 1 Non-Medicare

Medical Plan Monthly Retiree CostMonthly County ContributionMonthly Total Premium
County Health Plan EPO $1,193.29$500 $1,693.29
County Health Plan PPO $1,551.58$500 $2,051.58
Kaiser Permanente Traditional HMO $734.87$500 $1,234.87
Kaiser Permanente Hospital Services DHMO $558.77$500 $1,058.77
Kaiser Permanente Deductible First HDHP $506.31$500 $1,006.31
Kaiser Northwest$872.1$500$1,372.11
Kaiser Hawaii$839.34$500$1,339.34

Medicare dependents will be enrolled in Kaiser Senior Advantage.  Non-Medicare retirees and dependents will continue to be enrolled in standard Kaiser Permanente plans.   The benefit rates in this table list the combined rates for Medicare and non-Medicare recipients. 

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Level of Coverage:
1 Medicare + 2 or more Non-Medicare

Medical Plan Monthly Retiree CostMonthly County ContributionMonthly Total Premium
County Health Plan EPO$2,243.01$500 $2,743.01
County Health Plan PPO $2,839.76$500 $3,339.76
Kaiser Permanente Traditional HMO $1,485.15$500 $1,985.15
Kaiser Permanente Hospital Services DHMO $1,162.87$500 $1,662.87
Kaiser Permanente Deductible First HDHP $1,066.87$500 $1,566.87
Kaiser Northwest$1,928.08$500$2,428.08
Kaiser Hawaii$1,756.00$500$2,256.00

Medicare dependents will be enrolled in Kaiser Senior Advantage.  Non-Medicare retirees and dependents will continue to be enrolled in standard Kaiser Permanente plans.   The benefit rates in this table list the combined rates for Medicare and non-Medicare recipients.

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Contact Information

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Human Resources Department

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8:00 AM – 5:00 PM
Contact us by Phone
Address
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

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