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MEDICAL PLAN RATES
Your medical plan monthly cost depends on the plan and the coverage you choose, as well as your Medical Contribution Base (MCB). Your MCB is based on your full-time salary rate as of January 1, 2011, excluding any pay increases you may have received later during 2011. Medical plan rates are tiered (based on your MCB) so that the cost you pay for medical insurance is somewhat proportional to your pay rate. Your MCB will not change during 2012, even if your salary changes.
Choose the appropriate chart below to see the monthly amount that will be deducted from your paycheck in 2012.
- 2012 Medical Plan Costs for MCB $48,000 or less
- 2012 Medical Plan Costs for MCB $48,001 to $96,000
- 2012 Medical Plan Costs for MCB $96,001 to 144,000
- 2012 Medical Plan Costs for MCB $144,001 or more
Medical Plan Costs - $48,000 or Less
Plan |
Self |
Self + Child(ren) |
Self + Adult |
Self + Adult + Child(ren) |
|
| Anthem Blue Cross PLUS | Employee Cost | $75.24 |
$135.43 |
$204.63 |
$264.83 |
| UC Contribution | 539.99 | 971.98 | 1,087.35 | 1,519.34 | |
| Anthem Blue Cross PPO | Employee Cost | $52.57 |
$94.63 |
$157.02 |
$199.09 |
| UC Contribution | 539.99 | 971.98 | 1,087.35 | 1,519.34 | |
| Anthem Lumenos PPO with HRA | Employee Cost | $8.07 |
$14.53 |
$16.95 |
$23.40 |
| UC Contribution | 513.02 | 923.43 | 1,077.34 | 1,487.76 | |
| Core | Employee Cost | $0.00 |
$0.00 |
$0.00 |
$0.00 |
| UC Contribution | 98.05 | 176.49 | 205.91 | 284.35 | |
| Health Net Blue & Gold | Employee Cost | $23.08 | $41.55 | $95.10 | $113.56 |
| UC Contribution | 539.99 | 971.98 | 1,087.35 | 1,519.34 | |
| Health Net HMO | Employee Cost | $79.27 |
$142.69 |
$213.10 |
$276.52 |
| UC Contribution | 539.99 | 971.98 | 1,087.35 | 1,519.34 | |
| Kaiser Permanente--California | Employee Cost | $8.07 |
$14.53 |
$16.95 |
$23.40 |
| UC Contribution | 496.32 | 893.37 | 1,042.27 | 1,439.33 | |
| Kaiser Permanente--Umbrella | Employee Cost | $95.92 |
$172.66 |
$248.06 |
$324.80 |
| UC Contribution | 539.99 | 971.98 | 1,087.35 | 1,519.34 | |
| Western Health Advantage | Employee Cost | $8.07 |
$14.53 |
$16.95 |
$23.40 |
| UC Contribution | 505.32 | 909.57 | 1,061.17 | 1,465.43 | |
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.
Medical Plan Costs - $48,001 to $96,000
Plan |
Self |
Self + Child(ren) |
Self + Adult |
Self + Adult + Child(ren) |
|
| Anthem Blue Cross PLUS | Employee Cost | $111.29 | $200.32 | $286.93 | $375.97 |
| UC Contribution | 503.94 | 907.09 | 1,005.05 | 1,408.20 | |
| Anthem Blue Cross PPO | Employee Cost | $88.62 | $159.52 | $239.32 | $310.23 |
| UC Contribution | 503.94 | 907.09 | 1,005.05 | 1,408.20 | |
| Anthem Lumenos PPO with HRA | Employee Cost | $44.12 | $79.42 | $99.25 | $134.54 |
| UC Contribution | 476.97 | 858.54 | 995.04 | 1,376.62 | |
| Core | Employee Cost | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | 98.05 | 176.49 | 205.91 | 284.35 | |
| Health Net Blue & Gold | Employee Cost | $59.13 | $106.44 | $177.40 | $224.70 |
| UC Contribution | 503.94 | 907.09 | 1,005.05 | 1,408.20 | |
| Health Net HMO | Employee Cost | $115.32 | $207.58 | $295.40 | $387.66 |
| UC Contribution | 503.94 | 907.09 | 1,005.05 | 1,408.20 | |
| Kaiser Permanente--California | Employee Cost | $44.12 | $79.42 | $99.25 | $134.54 |
| UC Contribution | 460.27 | 828.48 | 959.97 | 1,328.19 | |
| Kaiser Permanente--Umbrella | Employee Cost | $131.97 | $237.55 | $330.36 | $435.94 |
| UC Contribution | 503.94 | 907.09 | 1,005.05 | 1,408.20 | |
| Western Health Advantage | Employee Cost | $44.12 | $79.42 | $99.25 | $134.54 |
| UC Contribution | 469.27 | 844.68 | 978.87 | 1,354.29 | |
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.
Medical Plan Costs - $96,001 to $144,000
Plan |
Self |
Self + Child(ren) |
Self + Adult |
Self + Adult + Child(ren) |
|
| Anthem Blue Cross PLUS | Employee Cost | $148.29 | $266.92 | $360.69 | $479.33 |
| UC Contribution | 466.94 | 840.49 | 931.29 | 1,304.84 | |
| Anthem Blue Cross PPO | Employee Cost | $125.62 | $226.12 | $313.08 | $413.59 |
| UC Contribution | 466.94 | 840.49 | 931.29 | 1,304.84 | |
| Anthem Lumenos PPO with HRA | Employee Cost | $81.12 | $146.02 | $173.01 | $237.90 |
| UC Contribution | 439.97 | 791.94 | 921.28 | 1,273.26 | |
| Core | Employee Cost | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | 98.05 | 176.49 | 205.91 | 284.35 | |
| Health Net Blue & Gold | Employee Cost | $96.13 | $173.04 | $251.16 | $328.06 |
| UC Contribution | 466.94 | 840.49 | 931.29 | 1,304.84 | |
| Health Net HMO | Employee Cost | $152.32 | $274.18 | $369.16 | $491.02 |
| UC Contribution | 466.94 | 840.49 | 931.29 | 1,304.84 | |
| Kaiser Permanente--California | Employee Cost | $81.12 | $146.02 | $173.01 | $237.90 |
| UC Contribution | 423.27 | 761.88 | 886.21 | 1,224.83 | |
| Kaiser Permanente--Umbrella | Employee Cost | $168.97 | $304.15 | $404.12 | $539.30 |
| UC Contribution | 466.94 | 840.49 | 931.29 | 1,304.84 | |
| Western Health Advantage | Employee Cost | $81.12 | $146.02 | $173.01 | $237.90 |
| UC Contribution | 432.27 | 778.08 | 905.11 | 1,250.93 | |
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.
Medical Plan Costs - $144,001 or More
Plan |
Self |
Self + Child(ren) |
Self + Adult |
Self + Adult + Child(ren) |
|
| Anthem Blue Cross PLUS | Employee Cost | $186.60 | $335.88 | $437.11 | $586.40 |
| UC Contribution | 428.63 | 771.53 | 854.87 | 1,197.77 | |
| Anthem Blue Cross PPO | Employee Cost | $163.93 | $295.08 | $389.50 | $520.66 |
| UC Contribution | 428.63 | 771.53 | 854.87 | 1,197.77 | |
| Anthem Lumenos PPO with HRA | Employee Cost | $119.43 | $214.98 | $249.43 | $344.97 |
| UC Contribution | 401.66 | 722.98 | 844.86 | 1,166.19 | |
| Core | Employee Cost | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | 98.05 | 176.49 | 205.91 | 284.35 | |
| Health Net Blue & Gold | Employee Cost | $134.44 | $242.00 | $327.58 | $435.13 |
| UC Contribution | 428.63 | 771.53 | 854.87 | 1,197.77 | |
| Health Net HMO | Employee Cost | $190.63 | $343.14 | $445.58 | $598.09 |
| UC Contribution | 428.63 | 771.53 | 854.87 | 1,197.77 | |
| Kaiser Permanente--California | Employee Cost | $119.43 | $214.98 | $249.43 | $344.97 |
| UC Contribution | 384.96 | 692.92 | 809.79 | 1,117.76 | |
| Kaiser Permanente--Umbrella | Employee Cost | $207.28 | $373.11 | $480.54 | $646.37 |
| UC Contribution | 428.63 | 771.53 | 854.87 | 1,197.77 | |
| Western Health Advantage | Employee Cost | $119.43 | $214.98 | $249.43 | $344.97 |
| UC Contribution | 393.96 | 709.12 | 828.69 | 1,143.86 | |
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.