Salinas City Council
October 22, 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 Party Party Subscriber & Plan Party Party Subscriber & Plan Party Party Plan Subscriber Code Code Rate 1 Dependent Code Code Rate 2+ Dependents Code Code Kale Anthem Blue Cross Select HMO $1,256.65 506 $2,513.30 506 2 $3,267.29 506 3 Anthem Blue Cross Traditional HMO $1,500.40 509 $3,000.80 509 2 2 $3,901.04 509 3 Blue Shield Access+ HMO $1,170.17 525 $2,340.34 525 2 $3,042.44 525 3 Blue Shield Access+ EPO $1,170.17 524฿ $2,340.34 524 2 2 $3,042.44 524 3 3 Blue Shield Trio HMO $1,134.79 451 $2,269.58 451 2 $2,950.45 451 3 Kaiser Permanente $1,112.90 533 $2,225.80 533 $2,893.54 533 Peace Officers Research Assoc of CA $975.00 592 $2,218.00 592 2 2 $2,777.00 592 3 PERS Gold $1,013.70 648 $2,027.40 648 2 $2,635.62 648
PERS Platinum $1,476.10| 657 $2,952.20 657 2 2 $3,837.86 657 3 UnitedHealthcare Signature Value Alliance $1,184.58 576 $2,369.16 576 $3,079.91 576 3 3 UnitedHealthcare Signature Value Harmony $1,005.02 495 $2,010.04 495 NINN 2 $2,613.05 495 3 Western Health Advantage HMO $914.27 591 $1,828.54 591 $2,377.10 591 3 Supplement/Managed Medicare Monthly Premiums (M)
Plan Party Party Subscriber & Plan Party Party Subscriber & Plan Party Party Plan Subscriber Code Code Rate 1 Dependent Code Code Rate 2+ Dependents Code Code Rate Anthem Medicare Preferred PPO $487.56 515 1 $975.12 515 5 $1,462.68 515 Anthem Medicare Preferred PPO with Dental/Vision' N N
$487.56 512 4 $975.12 512 5 $1,462.68 512
Anthem Medicare Preferred PPO $487.56 455 $975.12 455 2 5 $1,462.68 455 Anthem Medicare Preferred PPO with Dental/Vision1 $487.56 459 4 $975.12 459 $1.462.68 459 NN
Blue Shield Medicare PPO $448.28 011 $896.56 011 $1,344.84 011 Blue Shield Medicare PPO with Dental/Vision? $448.28 016 4 $896.56 016 5 $1,344.84 016 N N
Kaiser Permanente Senior Advantage $343.08 536 4 $686.16 536 5 $1,029.24 536 Kaiser Permanente Senior Advantage with Dental? $343.08 542 4 $686.16 542 2 5 $1,029.24 542 Kaiser Permanente Senior Advantage Summit $408.31 630 1 4 $816.62 630 2 5 $1,224.93 630 3 Kaiser Permanente Senior Advantage Summit with Dental? $408.31 636 $816.62 636 5 $1,224.93 636 3 Peace Officers Research Assoc of CA Medicare Supplement $507.00 595 $1,123.00 595 2 5 $1,521.00 595 3 PERS Gold Medicare Supplement $546.13 651 4 $1,092.26 $1,638.39 651 PERS Platinum Medicare Supplement $584.70 661 $1,169.40 $1,754.10 661 UnitedHealthcare Group Medicare Advantage PPO $442.25 579 $884.50 NNNN $1,326.75 579 co coco co UnitedHealthcare Group Medicare Advantage PPO with
Dental/Vision* $442.25 585 1 $884.50 585 $1,326.75 585
*For health plan availability by county, please refer to the 2025 Health Benefit Summary or myCalPERS 'Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount. "Dental and Vision coverage is an additional $39.14 per member per month premium. You will be billed directly for this amount. "Dental benefit is an additional $15.97 per member per month premium. You will be billed directly for this amount. *Dental and Vision coverage is an additional $29.54 per member per month premium. You will be billed directly for this amount.