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Monthly Medical Premiums for Retirees Non-Medicare

Effective Dates:

June 1, 2022 - May 31, 2023

Retiree - Non-Medicare

Medical Plan Monthly Retiree Cost Monthly County Contribution Monthly Total Premium
County Health Plan EPO $491.86 $500.00 $991.86
County Health Plan PPO $701.74 $500.00 $1,201.74
Kaiser Permanente Traditional HMO $483.90 $500.00 $983.90
Kaiser Permanente Hospital Services DHMO $256.00 $500.00 $756.00
Kaiser Permanente Deductible First HDHP $201.50 $500.00 $701.50
Kaiser Northwest $651.75 $500.00 $1,151.75
Kaiser Hawaii $485.24 $500.00 $985.24
Sutter Health Plus HMO $220.70 $500.00 $720.70
Sutter Health Plus Hospital Services DHMO $118.30 $500.00 $618.30
Sutter Health Plus Deductible First HDHP $74.40 $500.00 $574.40
Western Health Advantage HMO $226.08 $500.00 $726.08
Western Health Advantage Hospital Services DHMO $101.90 $500.00 $601.90
Western Health Advantage Deductible First HDHP $45.86 $500.00 $545.86

Retiree + 1 - Both Non-Medicare

Medical Plan Monthly Retiree Cost Monthly County Contribution Monthly Total Premium
County Health Plan EPO $1,437.56 $500.00 $1,937.56
County Health Plan PPO $1,862.26 $500.00 $2,362.26
Kaiser Permanente Traditional HMO $1,377.80 $500.00 $1,877.80
Kaiser Permanente Hospital Services DHMO $1,012.00 $500.00 $1,512.00
Kaiser Permanente Deductible First HDHP $903.00 $500.00 $1,403.00
Kaiser Northwest $1,803.50 $500.00 $2,303.50
Kaiser Hawaii $1,470.48 $500.00 $1,970.48
Sutter Health Plus HMO $941.50 $500.00 $1,441.50
Sutter Health Plus Hospital Services DHMO $736.70 $500.00 $1,236.70
Sutter Health Plus Deductible First HDHP $648.80 $500.00 $1,148.80
Western Health Advantage HMO $952.18 $500.00 $1,452.18
Western Health Advantage Hospital Services DHMO $703.84 $500.00 $1,203.84
Western Health Advantage Deductible First HDHP $591.74 $500.00 $1,091.74

Retiree + 2 or more - All Non-Medicare

Medical Plan Monthly Retiree Cost Monthly County Contribution Monthly Total Premium
County Health Plan EPO $2,202.62 $500.00 $2,702.62
County Health Plan PPO $2,801.14 $500.00 $3,301.14
Kaiser Permanente Traditional HMO $2,157.10 $500.00 $2,657.10
Kaiser Permanente Hospital Services DHMO $1,639.48 $500.00 $2,139.48
Kaiser Permanente Deductible First HDHP $1,485.24 $500.00 $1,985.24
Kaiser Northwest $2,955.25 $500.00 $3,455.25
Kaiser Hawaii $2,455.72 $500.00 $2,955.72
Sutter Health Plus HMO $1,540.00 $500.00 $2,040.00
Sutter Health Plus Hospital Services DHMO $1,250.00 $500.00 $1,750.00
Sutter Health Plus Deductible First HDHP $1,125.60 $500.00 $1,625.60
Western Health Advantage HMO $1,554.84 $500.00 $2,054.84
Western Health Advantage Hospital Services DHMO $1,203.44 $500.00 $1,703.44
Western Health Advantage Deductible First HDHP $1,044.82 $500.00 $1,544.82

1 Medicare + 1 Non-Medicare

Medical Plan Monthly Retiree Cost Monthly County Contribution Monthly Total Premium
County Health Plan EPO $1,025.49 $500.00 $1,525.49
County Health Plan PPO $1,348.26 $500.00 $1,848.26
Kaiser Permanente Traditional HMO $737.86 $500.00 $1,237.86
Kaiser Permanente Hospital Services DHMO $554.96 $500.00 $1,054.96
Kaiser Permanente Deductible First HDHP $500.46 $500.00 $1,000.46
Kaiser Northwest $970.37 $500.00 $1,470.37
Kaiser Hawaii $907.92 $500.00 $1,407.92
Western Health Advantage Traditional HMO $593.60 $500.00 $1,093.60
Western Health Advantage Hospital Services DHMO $469.44 $500.00 $969.44
Western Health Advantage Deductible First HDHP $413.38 $500.00 $913.38

Medicare retirees and dependents enrolled in a Kaiser Permanente plan will be enrolled in the Kaiser Senior Advantage. Non-Medicare dependents will continue to be enrolled in standard Kaiser Permanente plans.

Medicare Retirees and dependents enrolled in a Western Health Advantage plan will be enrolled in the or Western Health Advantage Medicare Advantage plan. Non-Medicare dependents will continue to be enrolled in standard Western Health Advantage plans.

The benefit rates in this table list the combined rates for Medicare and non-Medicare recipients.

1 Medicare + 2 or more Non-Medicare

Medical Plan Monthly Retiree Cost Monthly County Contribution Monthly Total Premium
County Health Plan EPO $1,971.19 $500.00 $2,471.19
County Health Plan PPO $2,508.78 $500.00 $3,008.78
Kaiser Permanente Traditional HMO $1,517.16 $500.00 $2,017.16
Kaiser Permanente Hospital Services DHMO $1,182.44 $500.00 $1,682.44
Kaiser Permanente Deductible First HDHP $1,082.70 $500.00 $1,582.70
Kaiser Northwest $2,122.12 $500.00 $2,622.12
Kaiser Hawaii $1,893.16 $500.00 $2,393.16
Western Health Advantage Traditional HMO $1,196.26 $500.00 $1,696.26
Western Health Advantage Hospital Services DHMO $969.04 $500.00 $1,469.04
Western Health Advantage Deductible First HDHP $866.46 $500.00 $1,366.46

Medicare retirees and dependents enrolled in a Kaiser Permanente plan will be enrolled in the Kaiser Senior Advantage. Non-Medicare dependents will continue to be enrolled in standard Kaiser Permanente plans.

Medicare Retirees and dependents enrolled in a Western Health Advantage plan will be enrolled in the or Western Health Advantage Medicare Advantage plan. Non-Medicare dependents will continue to be enrolled in standard Western Health Advantage plans.

The benefit rates in this table list the combined rates for Medicare and non-Medicare recipients.