Finance Committee
September 10, 2024

CalPERS 2025 Regional Health Premiums (Actives and Annuitants) Effective Date: January 1, 2025
Region 1*
Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, Yuba Basic Monthly Premiums (B)
Plan Subscriber
Plan
Code
Party
Code
Party
Rate
Subscriber &
1 Dependent
Plan
Code
Party
Code
Party
Rate
Subscriber &
2+ Dependents
Plan
Code
Party
Code
Party
Rate
Anthem Blue Cross Select HMO 1,256.65 506 1 1 2,513.30 506 2 2 3,267.29 506 3 3 Anthem Blue Cross Traditional HMO 1,500.40 509 1 1 3,000.80 509 2 2 3,901.04 509 3 3 Blue Shield Access+ HMO 1,170.17 525 1 1 2,340.34 525 2 2 3,042.44 525 3 3 Blue Shield Access+ EPO 1,170.17 524 1 1 2,340.34 524 2 2 3,042.44 524 3 3 Blue Shield Trio HMO 1,134.79 451 1 1 2,269.58 451 2 2 2,950.45 451 3 3 Kaiser Permanente 1,112.90 533 1 1 2,225.80 533 2 2 2,893.54 533 3 3 Peace Officers Research Assoc of CA 975.00 592 1 1 2,218.00 592 2 2 2,777.00 592 3 3 PERS Gold 1,013.70 648 1 1 2,027.40 648 2 2 2,635.62 648 3 3 PERS Platinum 1,476.10 657 1 1 2,952.20 657 2 2 3,837.86 657 3 3 UnitedHealthcare SignatureValue Alliance 1,184.58 576 1 1 2,369.16 576 2 2 3,079.91 576 3 3 UnitedHealthcare SignatureValue Harmony 1,005.02 495 1 1 2,010.04 495 2 2 2,613.05 495 3 3 Western Health Advantage HMO 914.27 591 1 1 1,828.54 591 2 2 2,377.10 591 3 3 Supplement/Managed Medicare Monthly Premiums (M)
Plan Subscriber
Plan
Code
Party
Code
Party
Rate
Subscriber &
1 Dependent
Plan
Code
Party
Code
Party
Rate
Subscriber &
2+ Dependents
Plan
Code
Party
Code
Party
Rate
Anthem Medicare Preferred PPO $487.56 515 1 4 $975.12 515 2 5 $1,462.68 515 3 6 Anthem Medicare Preferred PPO with Dental/Vision1 487.56 512 1 4 975.12 512 2 5 1,462.68 512 3 6 Anthem Medicare Preferred PPO 487.56 455 1 4 975.12 455 2 5 1,462.68 455 3 6 Anthem Medicare Preferred PPO with Dental/Vision1 487.56 459 1 4 975.12 459 2 5 1,462.68 459 3 6 Blue Shield Medicare PPO 448.28 011 1 4 896.56 011 2 5 1,344.84 011 3 6 Blue Shield Medicare PPO with Dental/Vision2 448.28 016 1 4 896.56 016 2 5 1,344.84 016 3 6 Kaiser Permanente Senior Advantage 343.08 536 1 4 686.16 536 2 5 1,029.24 536 3 6 Kaiser Permanente Senior Advantage with Dental3 343.08 542 1 4 686.16 542 2 5 1,029.24 542 3 6 Kaiser Permanente Senior Advantage Summit 408.31 630 1 4 816.62 630 2 5 1,224.93 630 3 6 Kaiser Permanente Senior Advantage Summit with Dental3 408.31 636 1 4 816.62 636 2 5 1,224.93 636 3 6 Peace Officers Research Assoc of CA Medicare Supplement 507.00 595 1 4 1,123.00 595 2 5 1,521.00 595 3 6 PERS Gold Medicare Supplement 546.13 651 1 4 1,092.26 651 2 5 1,638.39 651 3 6 PERS Platinum Medicare Supplement 584.70 661 1 4 1,169.40 661 2 5 1,754.10 661 3 6 UnitedHealthcare Group Medicare Advantage PPO 442.25 579 1 4 884.50 579 2 5 1,326.75 579 3 6 UnitedHealthcare Group Medicare Advantage PPO with
Dental/Vision4 442.25 585 1 4 884.50 585 2 5 1,326.75 585 3 6 *For health plan availability by county, please refer to the 2025 Health Benefit Summary or myCalPERS. 1Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount. 2Dental and Vision coverage is an additional $39.14 per member per month premium. You will be billed directly for this amount. 3Dental benefit is an additional $15.97 per member per month premium. You will be billed directly for this amount. 4Dental and Vision coverage is an additional $29.54 per member per month premium. You will be billed directly for this amount. 3 CalPERS 2025 Regional Health Premiums (Actives and Annuitants) Effective Date: January 1, 2025
Region 1*
Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, Yuba Combination Monthly Premiums
Plan
Subscriber in M, &
1 Dependent in B
Plan
Code
Party
Code
Party
Rate
Subscriber in M, &
2+ Dependents in B
Plan
Code
Party
Code
Party
Rate
Subscriber in M,
1 Dependent in M, &
1+ Dependent in B
Plan
Code
Party
Code
Party
Rate
Anthem Blue Cross Select HMO and Medicare Preferred 1,744.21 457 4 7 2,498.20 457 5 8 1,729.11 457 6 9 Anthem Blue Cross Select HMO and Medicare Preferred with Dental/Vision1 1,744.21 460 4 7 2,498.20 460 5 8 1,729.11 460 6 9 Anthem Blue Cross Traditional HMO and Medicare Preferred 1,987.96 518 4 7 2,888.20 518 5 8 1,875.36 518 6 9 Anthem Blue Cross Traditional HMO and Medicare Preferred with Dental/Vision1 1,987.96 521 4 7 2,888.20 521 5 8 1,875.36 521 6 9 Blue Shield Access+ HMO and Medicare 1,618.45 049 4 7 2,320.55 049 5 8 1,598.66 049 6 9 Blue Shield Access+ HMO and Medicare with Dental/Vision2 1,618.45 089 4 7 2,320.55 089 5 8 1,598.66 089 6 9 Blue Shield Access+ EPO and Medicare 1,618.45 092 4 7 2,320.55 092 5 8 1,598.66 092 6 9 Blue Shield Access+ EPO and Medicare with Dental/Vision3 1,618.45 093 4 7 2,320.55 093 5 8 1,598.66 093 6 9 Blue Shield Trio HMO and Medicare 1,583.07 094 4 7 2,263.94 094 5 8 1,577.43 094 6 9 Blue Shield Trio HMO and Medicare with Dental/Vision4 1,583.07 097 4 7 2,263.94 097 5 8 1,577.43 097 6 9 Kaiser Permanente and Senior Advantage 1,455.98 539 4 7 2,123.72 539 5 8 1,353.90 539 6 9 Kaiser Permanente and Senior Advantage with Dental5 1,455.98 545 4 7 2,123.72 545 5 8 1,353.90 545 6 9 Kaiser Permanente and Senior Advantage Summit 1,521.21 633 4 7 2,188.95 633 5 8 1,484.36 633 6 9 Kaiser Permanente and Senior Advantage Summit with Dental5 1,521.21 639 4 7 2,188.95 639 5 8 1,484.36 639 6 9 Peace Officers Research Assoc of CA and Medicare Supplement 1,750.00 598 4 7 2,309.00 598 5 8 1,678.00 598 6 9 PERS Gold and Medicare Supplement 1,559.83 654 4 7 2,168.05 654 5 8 1,700.48 654 6 9 PERS Platinum and Medicare Supplement 2,060.80 665 4 7 2,946.46 665 5 8 2,055.06 665 6 9 UnitedHealthcare SignatureValue Alliance and Group Medicare Advantage PPO 1,626.83 582 4 7 2,337.58 582 5 8 1,595.25 582 6 9 UnitedHealthcare SignatureValue Alliance and Group Medicare Advantage PPO with Dental/Vision6 1,626.83 588 4 7 2,337.58 588 5 8 1,595.25 588 6 9 UnitedHealthcare SignatureValue Harmony and Group Medicare Advantage PPO 1,447.27 497 4 7 2,050.28 497 5 8 1,487.51 497 6 9 UnitedHealthcare SignatureValue Harmony and Group Medicare Advantage PPO with Dental/Vision6 1,447.27 498 4 7 2,050.28 498 5 8 1,487.51 498 6 9 4 CalPERS 2025 Regional Health Premiums (Actives and Annuitants) Effective Date: January 1, 2025
Region 1*
Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, Yuba Combination Monthly Premiums (Continued)
Plan
Subscriber in B, &
1 Dependent in M
Plan
Code
Party
Code
Party
Rate
Subscriber in B, &
2+ Dependents in M
Plan
Code
Party
Code
Party
Rate
Subscriber in B,
1 Dependent in M, &
1+ Dependent in B
Plan
Code
Party
Code
Party
Rate
Anthem Blue Cross Select HMO and Medicare Preferred 1,744.21 457 7 10 2,231.77 457 8 11 2,498.20 457 9 12 Anthem Blue Cross Select HMO and Medicare Preferred with Dental/Vision1 1,744.21 460 7 10 2,231.77 460 8 11 2,498.20 460 9 12 Anthem Blue Cross Traditional HMO and Medicare Preferred 1,987.96 518 7 10 2,475.52 518 8 11 2,888.20 518 9 12 Anthem Blue Cross Traditional HMO and Medicare Preferred with Dental/Vision1 1,987.96 521 7 10 2,475.52 521 8 11 2,888.20 521 9 12 Blue Shield Access+ HMO and Medicare 1,618.45 049 7 10 2,066.73 049 8 11 2,320.55 049 9 12 Blue Shield Access+ HMO and Medicare with Dental/Vision2 1,618.45 089 7 10 2,066.73 089 8 11 2,320.55 089 9 12 Blue Shield Access+ EPO and Medicare 1,618.45 092 7 10 2,066.73 092 8 11 2,320.55 092 9 12 Blue Shield Access+ EPO and Medicare with Dental/Vision3 1,618.45 093 7 10 2,066.73 093 8 11 2,320.55 093 9 12 Blue Shield Trio HMO and Medicare 1,583.07 094 7 10 2,031.35 094 8 11 2,263.94 094 9 12 Blue Shield Trio HMO and Medicare with Dental/Vision4 1,583.07 097 7 10 2,031.35 097 8 11 2,263.94 097 9 12 Kaiser Permanente and Senior Advantage 1,455.98 539 7 10 1,799.06 539 8 11 2,123.72 539 9 12 Kaiser Permanente and Senior Advantage with Dental5 1,455.98 545 7 10 1,799.06 545 8 11 2,123.72 545 9 12 Kaiser Permanente and Senior Advantage Summit 1,521.21 633 7 10 1,929.52 633 8 11 2,188.95 633 9 12 Kaiser Permanente and Senior Advantage Summit with Dental5 1,521.21 639 7 10 1,929.52 639 8 11 2,188.95 639 9 12 Peace Officers Research Assoc of CA and Medicare Supplement 1,482.00 598 7 10 2,098.00 598 8 11 2,309.00 598 9 12 PERS Gold and Medicare Supplement 1,559.83 654 7 10 2,105.96 654 8 11 2,168.05 654 9 12 PERS Platinum and Medicare Supplement 2,060.80 665 7 10 2,645.50 665 8 11 2,946.46 665 9 12 UnitedHealthcare SignatureValue Alliance and Group Medicare Advantage PPO 1,626.83 582 7 10 2,069.08 582 8 11 2,337.58 582 9 12 UnitedHealthcare SignatureValue Alliance and Group Medicare Advantage PPO with Dental/Vision6 1,626.83 588 7 10 2,069.08 588 8 11 2,337.58 588 9 12 UnitedHealthcare SignatureValue Harmony and Group Medicare Advantage PPO 1,447.27 497 7 10 1,889.52 497 8 11 2,050.28 497 9 12 UnitedHealthcare SignatureValue Harmony and Group Medicare Advantage PPO with Dental/Vision6 1,447.27 498 7 10 1,889.52 498 8 11 2,050.28 498 9 12 1Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount. 2Dental and Vision coverage is an additional $39.14 per member per month premium. You will be billed directly for this amount. 3Dental and Vision coverage is an additional $39.14 per member per month premium. You will be billed directly for this amount. 4Dental and Vision coverage is an additional $39.14 per member per month premium. You will be billed directly for this amount. 5Dental benefit is an additional $15.97 per member per month premium. You will be billed directly for this amount. 6Dental and Vision coverage is an additional $29.54per member per month premium. You will be billed directly for this amount. 5