1Questions? Email the Benefits Team at [email protected] Full-Time Fire Mgt, Fire, SPMA, and SPOA Employees
Kaiser Permanente POS Plan – Medical, Dental and Vision Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,724.71 $711.00 $1,013.71 $506.86
Employee + 1 $3,108.06 $1,290.00 $1,818.06 $909.03
Employee + Family $4,175.64 $1,719.00 $2,456.64 $1,228.32 Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,761.73 $711.00 $1,050.73 $525.37
Employee + 1 $3,183.51 $1,290.00 $1,893.51 $946.76
Employee + Family $4,240.08 $1,719.00 $2,521.08 $1,260.54 Kaiser HDHP HSA Plan – Medical, Dental and Vision
Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $692.43 $692.43 $0.00 $0.00
Employee + 1 $1,249.96 $1,249.96 $0.00 $0.00
Employee + Family $1,698.18 $1,698.18 $0.00 $0.00
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $729.45 $711.00 $18.45 $9.22
Employee + 1 $1,325.41 $1,290.00 $35.41 $17.71
Employee + Family $1,762.62 $1,719.00 $43.62 $21.81
Kaiser HMO Plan- Medical, Dental and Vision
Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $828.96 $711.00 $117.96 $58.98
Employee + 1 $1,495.71 $1,290.00 $205.71 $102.86
Employee + Family $2,025.85 $1,719.00 $306.85 $153.43
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $865.98 $711.00 $154.98 $77.49
Employee + 1 $1,571.16 $1,290.00 $281.16 $140.58
Employee + Family $2,090.29 $1,719.00 $371.29 $185.65
Cost of Coverage
ATTACHMENT B
2Questions? Email the Benefits Team at [email protected] Full-Time Fire Mgt, Fire, SPMA, and SPOA Employees
Sutter Health Plus HDHP HSA Plan – Medical, Dental and Vision Sutter Health Plus HMO Plan – Medical, Dental and Vision Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $723.69 $711.00 $12.69 $6.34
Employee + 1 $1,306.21 $1,290.00 $16.21 $8.11
Employee + Family $1,773.14 $1,719.00 $54.14 $27.07
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $760.71 $711.00 $49.71 $24.86
Employee + 1 $1,381.66 $1,290.00 $91.66 $45.83
Employee + Family $1,837.58 $1,719.00 $118.58 $59.29
Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $848.99 $711.00 $137.99 $68.99
Employee + 1 $1,532.71 $1,290.00 $242.71 $121.36
Employee + Family $2,075.84 $1,719.00 $356.84 $178.42
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $886.01 $711.00 $175.01 $87.50
Employee + 1 $1,608.16 $1,290.00 $318.16 $159.08
Employee + Family $2,140.28 $1,719.00 $421.28 $210.64
Cost of Coverage
ATTACHMENT B
3Questions? Email the Benefits Team at [email protected] Full-Time SCEA/UNREP, B&C, O&M, T&M, and WS Employees
Kaiser Permanente POS Plan – Medical, Dental and Vision Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,724.71 $697.00 $1,027.71 $513.86
Employee + 1 $3,108.06 $1,265.00 $1,843.06 $921.53
Employee + Family $4,175.64 $1,685.00 $2,490.64 $1,245.32 Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,761.73 $697.00 $1,064.73 $532.37
Employee + 1 $3,183.51 $1,265.00 $1,918.51 $959.26
Employee + Family $4,240.08 $1,685.00 $2,555.08 $1,277.54 Kaiser HDHP HSA Plan – Medical, Dental and Vision
Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $692.43 $692.43 $0.00 $0.00
Employee + 1 $1,249.96 $1,249.96 $0.00 $0.00
Employee + Family $1,698.18 $1,685.00 $13.18 $6.59
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $729.45 $697.00 $32.45 $16.23
Employee + 1 $1,325.41 $1,265.00 $60.41 $30.21
Employee + Family $1,762.62 $1,685.00 $77.62 $38.81
Kaiser HMO Plan- Medical, Dental and Vision
Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $828.96 $697.00 $131.96 $65.98
Employee + 1 $1,495.71 $1,265.00 $230.71 $115.36
Employee + Family $2,025.85 $1,685.00 $340.85 $170.43
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $865.98 $697.00 $168.98 $84.49
Employee + 1 $1,571.16 $1,265.00 $306.16 $153.08
Employee + Family $2,090.29 $1,685.00 $405.29 $202.65
Cost of Coverage
ATTACHMENT B
4Questions? Email the Benefits Team at [email protected] Full-Time SCEA/UNREP, B&C, O&M, T&M, and WS Employees
Sutter Health Plus HDHP HSA Plan – Medical, Dental and Vision Sutter Health Plus HMO Plan – Medical, Dental and Vision Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $723.69 $697.00 $26.69 $13.35
Employee + 1 $1,306.21 $1,265.00 $41.21 $20.61
Employee + Family $1,773.14 $1,685.00 $88.14 $44.07
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $760.71 $697.00 $63.71 $31.86
Employee + 1 $1,381.66 $1,265.00 $116.66 $58.33
Employee + Family $1,837.58 $1,685.00 $152.58 $76.29
Tier
with DHMO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $848.99 $697.00 $151.99 $75.99
Employee + 1 $1,532.71 $1,265.00 $267.71 $133.86
Employee + Family $2,075.84 $1,685.00 $390.84 $195.42
Tier
with DPPO Dental
Total Monthly Employer Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $886.01 $697.00 $189.01 $94.50
Employee + 1 $1,608.16 $1,265.00 $343.16 $171.58
Employee + Family $2,140.28 $1,685.00 $455.28 $227.64
Cost of Coverage
ATTACHMENT B