University of California Human Resources and Benefits

Medical Plan Costs - $47,000 or Less

Plan	Self	Self + Child(ren)	Self + Adult	Self + Adult + Child(ren)
Anthem Blue Cross PLUS	77.49	139.48	205.60	267.59
Anthem Blue Cross PPO	93.32	167.98	238.85	313.49
Anthem Lumenos PPO with HRA	7.45	13.41	17.02	21.61
Core	$0.00	$0.00	$0.00	$0.00
Health Net Blue & Gold	21.21	38.18	87.41	104.38
Health Net HMO	74.40	133.92	199.11	258.63
Kaiser Permanente--California	7.45	13.41	15.65	21.61
Kaiser Permanente--Umbrella	114.62	206.32	283.57	375.27
Western Health Advantage	7.45	13.41	15.65	21.61

Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.

Medical Plan Costs - $47,001 to $93,000

Plan	Self	Self + Child(ren)	Self + Adult	Self + Adult + Child(ren)
Anthem Blue Cross PLUS	110.64	199.15	281.28	369.79
Anthem Blue Cross PPO	126.47	227.65	314.53	415.69
Anthem Lumenos PPO with HRA	40.60	73.08	92.7	123.81
Core	$0.00	$0.00	$0.00	$0.00
Health Net Blue & Gold	54.36	97.85	163.09	206.58
Health Net HMO	107.55	193.59	274.79	360.83
Kaiser Permanente--California	40.60	73.08	91.33	123.81
Kaiser Permanente--Umbrella	147.77	265.99	359.25	477.47
Western Health Advantage	40.60	73.08	91.33	123.81

Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.

Medical Plan Costs - $93,001 to 140,000

Plan	Self	Self + Child(ren)	Self + Adult	Self + Adult + Child(ren)
Anthem Blue Cross PLUS	144.66	260.39	349.10	464.83
Anthem Blue Cross PPO	160.49	288.89	382.35	510.73
Anthem Lumenos PPO with HRA	74.62	134.32	160.52	218.85
Core	$0.00	$0.00	$0.00	$0.00
Health Net Blue & Gold	88.38	159.09	230.91	301.62
Health Net HMO	141.57	254.83	342.61	455.87
Kaiser Permanente--California	$74.62	$134.32	$159.15	$218.85
Kaiser Permanente--Umbrella	181.79	327.23	427.07	572.51
Western Health Advantage	$74.62	$134.32	$159.15	$218.85

Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.

Medical Plan Costs - $140,001 or More

Plan	Self	Self + Child(ren)	Self + Adult	Self + Adult + Child(ren)
Anthem Blue Cross PLUS	179.88	323.79	419.36	563.26
Anthem Blue Cross PPO	195.71	352.29	452.61	609.16
Anthem Lumenos PPO with HRA	$109.84	$197.72	$230.78	$317.28
Core	$0.00	$0.00	$0.00	$0.00
Health Net Blue & Gold	123.60	222.49	301.17	400.05
Health Net HMO	176.79	318.23	412.87	554.30
Kaiser Permanente--California	$109.84	$197.72	$229.41	$317.28
Kaiser Permanente--Umbrella	217.01	390.63	497.33	670.94
Western Health Advantage	$109.84	$197.72	$229.41	$317.28

Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.

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