Cost of Coverage
Full-Time Employees (excluding SPOA members)
Effective 1/1/2027
Kaiser Permanente HMO Plan - Medical, Dental and Vision Tier with DHMO Dental
Total Monthly
Premium
City Monthly
Contribution
Employee
Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,007.76 $973.54 $34.22 $17.11
Employee + 1 $1,817.43 $1,766.49 $50.94 $25.47
Employee + Family $2,451.21 $2,353.73 $97.48 $48.74
Tier with DPPO Dental
Total Monthly
Premium
City Monthly
Contribution
Employee
Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,047.74 $973.54 $74.20 $37.10
Employee + 1 $1,898.60 $1,766.49 $132.11 $66.05
Employee + Family $2,527.21 $2,353.73 $173.48 $86.74
Kaiser Permanente DEDUCTIBLE HMO Plan - Medical, Dental and Vision Tier with DHMO Dental
Total Monthly
Premium
City Monthly
Contribution
Employee
Monthly
Contribution
Per Paycheck
Deduction
Employee Only $881.16 $881.16 $0.00 $0.00
Employee + 1 $1,589.55 $1,589.55 $0.00 $0.00
Employee + Family $2,147.37 $2,147.37 $0.00 $0.00
Tier with DPPO Dental
Total Monthly
Premium
City Monthly
Contribution
Employee
Monthly
Contribution
Per Paycheck
Deduction
Employee Only $921.14 $921.14 $0.00 $0.00
Employee + 1 $1,670.72 $1,670.72 $0.00 $0.00
Employee + Family $2,223.37 $2,223.37 $0.00 $0.00
Kaiser Permanente HDHP Plan - Medical, Dental and Vision Tier with DHMO Dental
Total Monthly
Premium
City Monthly
Contribution
Employee
Monthly
Contribution
Per Paycheck
Deduction
Employee Only $832.11 $832.11 $0.00 $0.00
Employee + 1 $1,501.25 $1,501.25 $0.00 $0.00
Employee + Family $2,029.65 $2,029.65 $0.00 $0.00
Tier with DPPO Dental
Total Monthly
Premium
City Monthly
Contribution
Employee
Monthly
Contribution
Per Paycheck
Deduction
Employee Only $872.09 $872.09 $0.00 $0.00
Employee + 1 $1,582.42 $1,582.42 $0.00 $0.00
Employee + Family $2,105.65 $2,105.65 $0.00 $0.00
ATTACHMENT B
Cost of Coverage
Full-Time Employees (excluding SPOA members) Effective 1/1/2027 Sutter Health Plus HMO Plan LG18- Medical, Dental and Vision Tier with DHMO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,384.27 $973.54 $410.73 $205.37
Employee + 1 $2,495.92 $1,766.49 $729.43 $364.72
Employee + Family $3,356.57 $2,353.73 $1,002.84 $501.42 Tier with DPPO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,424.25 $973.54 $450.71 $225.36
Employee + 1 $2,577.09 $1,766.49 $810.60 $405.30
Employee + Family $3,432.57 $2,353.73 $1,078.84 $539.42 Sutter Health Plus Deductible HMO Plan LG24 - Medical, Dental and Vision Tier with DHMO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,136.37 $973.54 $162.83 $81.42
Employee + 1 $2,049.72 $1,766.49 $283.23 $141.62
Employee + Family $2,761.67 $2,353.73 $407.94 $203.97
Tier with DPPO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,176.35 $973.54 $202.81 $101.41
Employee + 1 $2,130.89 $1,766.49 $364.40 $182.20
Employee + Family $2,837.67 $2,353.73 $483.94 $241.97
Sutter Health Plus HDHP Plan HE08 - Medical, Dental and Vision Tier with DHMO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,176.67 $973.54 $203.13 $101.57
Employee + 1 $2,121.42 $1,766.49 $354.93 $177.47
Employee + Family $2,856.57 $2,353.73 $502.84 $251.42
Tier with DPPO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,216.65 $973.54 $243.11 $121.56
Employee + 1 $2,202.59 $1,766.49 $436.10 $218.05
Employee + Family $2,932.57 $2,353.73 $578.84 $289.42
ATTACHMENT B
Sutter Health Plus HMO Plan LG22- Medical, Dental and Vision Tier with DHMO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,261.47 $973.54 $287.93 $143.97
Employee + 1 $2,274.92 $1,766.49 $508.43 $254.22
Employee + Family $3,061.87 $2,353.73 $708.14 $354.07
Tier with DPPO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,301.45 $973.54 $327.91 $163.96
Employee + 1 $2,356.09 $1,766.49 $589.60 $294.80
Employee + Family $3,137.87 $2,353.73 $784.14 $392.07
Sutter Health Plus Deductible HMO Plan LG29 - Medical, Dental and Vision Tier with DHMO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,008.77 $973.54 $35.23 $17.62
Employee + 1 $1,820.02 $1,766.49 $53.53 $26.77
Employee + Family $2,455.37 $2,353.73 $101.64 $50.82
Tier with DPPO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $1,048.75 $973.54 $75.21 $37.61
Employee + 1 $1,901.19 $1,766.49 $134.70 $67.35
Employee + Family $2,531.37 $2,353.73 $177.64 $88.82
Sutter Health Plus HDHP Plan HL12 - Medical, Dental and Vision Tier with DHMO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $880.37 $880.37 $0.00 $0.00
Employee + 1 $1,588.12 $1,588.12 $0.00 $0.00
Employee + Family $2,145.47 $2,145.47 $0.00 $0.00
Tier with DPPO
Dental
Total Monthly
Premium
City Monthly
Contribution
Employee Monthly
Contribution
Per Paycheck
Deduction
Employee Only $920.35 $920.35 $0.00 $0.00
Employee + 1 $1,669.29 $1,669.29 $0.00 $0.00
Employee + Family $2,221.47 $2,221.47 $0.00 $0.00
ATTACHMENT B