HomeMy WebLinkAbout2023 - Health RatesCalPERS 2023 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2023
Region 3*
Los Angeles, Riverside, San Bernardino
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 Rate
Anthem Blue Cross Select HMO $737.91 508 1 1 $1,475.82 508 2 2 $1,918.57 508 3 3
Anthem Blue Cross Traditional HMO 942.73 511 1 1 1,885.46 511 2 2 2,451.10 511 3 3
Blue Shield Access+ HMO 738.29 527 1 1 1,476.58 527 2 2 1,919.55 527 3 3
Blue Shield Trio HMO 661.49 452 1 1 1,322.98 452 2 2 1,719.87 452 3 3
Health Net Salud y Más 606.34 532 1 1 1,212.68 532 2 2 1,576.48 532 3 3
Health Net SmartCare 755.29 530 1 1 1,510.58 530 2 2 1,963.75 530 3 3
Kaiser Permanente 754.64 535 1 1 1,509.28 535 2 2 1,962.06 535 3 3
Peace Officers Research Assoc of CA 820.00 594 1 1 1,600.00 594 2 2 2,100.00 594 3 3
PERS Gold 680.37 615 1 1 1,360.74 615 2 2 1,768.96 615 3 3
PERS Platinum 992.59 603 1 1 1,985.18 603 2 2 2,580.73 603 3 3
UnitedHealthcare SignatureValue Alliance 790.46 578 1 1 1,580.92 578 2 2 2,055.20 578 3 3
UnitedHealthcare SignatureValue Harmony 713.55 475 1 1 1,427.10 475 2 2 1,855.23 475 3 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 $413.59 517 1 4 $827.18 517 2 5 $1,240.77 517 3 6
Anthem Medicare Preferred PPO with
Dental/Vision1 413.59 514 1 4 827.18 514 2 5 1,240.77 514 3 6
Anthem Medicare Preferred PPO 413.59 039 1 4 827.18 039 2 5 1,240.77 039 3 6
Anthem Medicare Preferred PPO with
Dental/Vision1 413.59 075 1 4 827.18 075 2 5 1,240.77 075 3 6
Blue Shield Medicare PPO 361.90 014 1 4 723.80 014 2 5 1,085.70 014 3 6
Blue Shield Medicare PPO with Dental/Vision2 361.90 047 1 4 723.80 047 2 5 1,085.70 047 3 6
Kaiser Permanente Senior Advantage 283.25 538 1 4 566.50 538 2 5 849.75 538 3 6
Kaiser Permanente Senior Advantage with
Dental3 283.25 544 1 4 566.50 544 2 5 849.75 544 3 6
Kaiser Permanente Senior Advantage Summit 336.29 632 1 4 672.58 632 2 5 1,008.87 632 3 6
Kaiser Permanente Senior Advantage Summit
with Dental3 336.29 638 1 4 672.58 638 2 5 1,008.87 638 3 6
Peace Officers Research Assoc of CA Medicare
Supplement 465.00 597 1 4 1,030.00 597 2 5 1,395.00 597 3 6
PERS Gold Medicare Supplement 392.71 618 1 4 785.42 618 2 5 1,178.13 618 3 6
PERS Platinum Medicare Supplement 420.02 607 1 4 840.04 607 2 5 1,260.06 607 3 6
UnitedHealthcare Group Medicare Advantage
PPO 299.68 581 1 4 599.36 581 2 5 899.04 581 3 6
UnitedHealthcare Group Medicare Advantage
Edge PPO 357.70 623 1 4 715.40 623 2 5 1,073.10 623 3 6
UnitedHealthcare Group Medicare Advantage
PPO with Dental/Vision4 299.68 587 1 4 599.36 587 2 5 899.04 587 3 6
*For health plan availability by county, please refer to the 2023 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 $38.00 per member per month premium. You will be billed directly for this amount.
3Dental benefit is an additional $15.35 per member per month premium. You will be billed directly for this amount.
4Dental and Vision coverage is an additional $26.03 per member per month premium. You will be billed directly for this amount.
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Updated: September 30, 2022
CalPERS 2023 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2023
Region 3
Los Angeles, Riverside, San Bernardino
Combination Monthly Premiums
Subscriber in M,
Subscriber in M, & Plan Party Party Subscriber in M, & Plan Party Party 1 Dependent in M, &Plan Party Party
Plan 1 Dependent in B Code Code Rate 2+ Dependents in B Code Code Rate 1+ Dependent in B Code Code Rate
Anthem Blue Cross Select HMO and Medicare
Preferred $1,151.50 041 4 7 $1,594.25 041 5 8 $1,269.93 041 6 9
Anthem Blue Cross Select HMO and Medicare
Preferred with Dental/Vision1 1,151.50 077 4 7 1,594.25 077 5 8 1,269.93 077 6 9
Anthem Blue Cross Traditional HMO and
Medicare Preferred 1,356.32 520 4 7 1,921.96 520 5 8 1,392.82 520 6 9
Anthem Blue Cross Traditional HMO and
Medicare Preferred with Dental/Vision1 1,356.32 523 4 7 1,921.96 523 5 8 1,392.82 523 6 9
Blue Shield Access+ HMO and Medicare 1,100.19 051 4 7 1,543.16 051 5 8 1,166.77 051 6 9
Blue Shield Access+ HMO and Medicare with
Dental/Vision2 1,100.19 091 4 7 1,543.16 091 5 8 1,166.77 091 6 9
Blue Shield Trio HMO and Medicare 1,023.39 096 4 7 1,420.28 096 5 8 1,120.69 096 6 9
Blue Shield Trio HMO and Medicare with
Dental/Vision3 1,023.39 099 4 7 1,420.28 099 5 8 1,120.69 099 6 9
Kaiser Permanente and Senior Advantage 1,037.89 541 4 7 1,490.67 541 5 8 1,019.28 541 6 9
Kaiser Permanente and Senior Advantage with
Dental4 1,037.89 547 4 7 1,490.67 547 5 8 1,019.28 547 6 9
Kaiser Permanente and Senior Advantage
Summit 1,090.93 635 4 7 1,543.71 635 5 8 1,125.36 635 6 9
Kaiser Permanente and Senior Advantage
Summit with Dental4 1,090.93 641 4 7 1,543.71 641 5 8 1,125.36 641 6 9
Peace Officers Research Assoc of CA and
Medicare Supplement 1,368.00 600 4 7 1,888.00 600 5 8 1,687.00 600 6 9
PERS Gold and Medicare Supplement 1,073.08 621 4 7 1,481.30 621 5 8 1,193.64 621 6 9
PERS Platinum and Medicare Supplement 1,412.61 611 4 7 2,008.16 611 5 8 1,435.59 611 6 9
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage PPO 1,090.14 584 4 7 1,564.42 584 5 8 1,073.64 584 6 9
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage Edge PPO 1,148.16 629 4 7 1,622.44 629 5 8 1,189.68 629 6 9
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage PPO with
Dental/Vision5
1,090.14 590 4 7 1,564.42 590 5 8 1,073.64 590 6 9
UnitedHealthcare SignatureValue Harmony and
Group Medicare Advantage PPO 1,013.23 774 4 7 1,441.36 774 5 8 1,027.49 774 6 9
UnitedHealthcare SignatureValue Harmony and
Group Medicare Advantage Edge PPO 1,071.25 626 4 7 1,499.38 626 5 8 1,143.53 626 6 9
UnitedHealthcare SignatureValue Harmony and
Group Medicare Advantage PPO with
Dental/Vision5
1,013.23 776 4 7 1,441.36 776 5 8 1,027.49 776 6 9
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 $38.00 per member per month premium. You will be billed directly for this amount.
3Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
4Dental benefit is an additional $15.35 per member per month premium. You will be billed directly for this amount.
5Dental and Vision coverage is an additional $26.03 per member per month premium. You will be billed directly for this amount.
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CalPERS 2023 Regional Health Premiums (Actives and Annuitants)
Effective Date: January 1, 2023
Region 3
Los Angeles, Riverside, San Bernardino
Combination Monthly Premiums (Continued)
Subscriber in B,
Subscriber in B, & Plan Party Party Subscriber in B, & Plan Party Party 1 Dependent in M, &Plan Party Party
Plan 1 Dependent in M Code Code Rate 2+ Dependents in M Code Code Rate 1+ Dependent in B Code Code Rate
Anthem Blue Cross Select HMO and Medicare
Preferred $1,151.50 041 7 10 $1,565.09 041 8 11 $1,594.25 041 9 12
Anthem Blue Cross Select HMO and Medicare
Preferred with Dental/Vision1 1,151.50 077 7 10 1,565.09 077 8 11 1,594.25 077 9 12
Anthem Blue Cross Traditional HMO and
Medicare Preferred 1,356.32 520 7 10 1,769.91 520 8 11 1,921.96 520 9 12
Anthem Blue Cross Traditional HMO and
Medicare Preferred with Dental/Vision1 1,356.32 523 7 10 1,769.91 523 8 11 1,921.96 523 9 12
Blue Shield Access+ HMO and Medicare 1,100.19 051 7 10 1,462.09 051 8 11 1,543.16 051 9 12
Blue Shield Access+ HMO and Medicare with
Dental/Vision2 1,100.19 091 7 10 1,462.09 091 8 11 1,543.16 091 9 12
Blue Shield Trio HMO and Medicare 1,023.39 096 7 10 1,385.29 096 8 11 1,420.28 096 9 12
Blue Shield Trio HMO and Medicare with
Dental/Vision3 1,023.39 099 7 10 1,385.29 099 8 11 1,420.28 099 9 12
Kaiser Permanente and Senior Advantage 1,037.89 541 7 10 1,321.14 541 8 11 1,490.67 541 9 12
Kaiser Permanente and Senior Advantage with
Dental4 1,037.89 547 7 10 1,321.14 547 8 11 1,490.67 547 9 12
Kaiser Permanente and Senior Advantage
Summit 1,090.93 635 7 10 1,427.22 635 8 11 1,543.71 635 9 12
Kaiser Permanente and Senior Advantage
Summit with Dental4 1,090.93 641 7 10 1,427.22 641 8 11 1,543.71 641 9 12
Peace Officers Research Assoc of CA and
Medicare Supplement 1,363.00 600 7 10 1,825.00 600 8 11 1,773.00 600 9 12
PERS Gold and Medicare Supplement 1,073.08 621 7 10 1,465.79 621 8 11 1,481.30 621 9 12
PERS Platinum and Medicare Supplement 1,412.61 611 7 10 1,832.63 611 8 11 2,008.16 611 9 12
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage PPO 1,090.14 584 7 10 1,389.82 584 8 11 1,564.42 584 9 12
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage Edge PPO 1,148.16 629 7 10 1,505.86 629 8 11 1,622.44 629 9 12
UnitedHealthcare SignatureValue Alliance and
Group Medicare Advantage PPO with
Dental/Vision5
1,090.14 590 7 10 1,389.82 590 8 11 1,564.42 590 9 12
UnitedHealthcare SignatureValue Harmony and
Group Medicare Advantage PPO 1,013.23 774 7 10 1,312.91 774 8 11 1,441.36 774 9 12
UnitedHealthcare SignatureValue Harmony and
Group Medicare Advantage Edge PPO 1,071.25 626 7 10 1,428.95 626 8 11 1,499.38 626 9 12
UnitedHealthcare SignatureValue Harmony and
Group Medicare Advantage PPO with
Dental/Vision5
1,013.23 776 7 10 1,312.91 776 8 11 1,441.36 776 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 $38.00 per member per month premium. You will be billed directly for this amount.
3Dental and Vision coverage is an additional $38.00 per member per month premium. You will be billed directly for this amount.
4Dental benefit is an additional $15.35 per member per month premium. You will be billed directly for this amount.
5Dental and Vision coverage is an additional $26.03 per member per month premium. You will be billed directly for this amount.
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