APPENDIX I
HEALTH BENEFITS RATES
2015 medical plan costs — $51,000 and under | |||||
Plan | Self | Self + | Self + | Family | |
Child(ren) | Adult | ||||
Blue Shield Health Savings Plan | Employee Cost | $15.78 | $28.40 | $34.56 | $47.17 |
UC Contribution | $609.00 | $1,096.19 | $1,277.46 | $1,764.68 | |
Health Net Blue & Gold | Employee Cost | $33.84 | $60.91 | $126.05 | $153.11 |
| UC Contribution | $636.75 | $1,146.15 | $1,282.19 | $1,791.59 | |
Kaiser Permanente | Employee Cost | $15.78 | $28.40 | $34.56 | $47.17 |
| UC Contribution | $571.08 | $1,027.94 | $1,197.85 | $1,654.72 | |
UC Care | Employee Cost | $114.92 | $206.86 | $296.33 | $388.26 |
| UC Contribution | $636.75 | $1,146.15 | $1,282.19 | $1,791.59 | |
Western Health Advantage | Employee Cost | $15.78 | $28.40 | $34.56 | $47.17 |
| UC Contribution | $562.03 | $1,011.66 | $1,178.85 | $1,628.48 | |
Core | Employee Cost | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | $235.87 | $424.57 | $495.33 | $684.02 | |
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate. | |||||
2015 medical plan costs — $51,001–$102,000 | |||||
Plan | Self | Self + | Self + | Family | |
| Child(ren) | Adult | ||||
Blue Shield Health Savings Plan | Employee Cost | $51.83 | $93.29 | $116.86 | $158.31 |
| UC Contribution | $572.95 | $1,031.30 | $1,195.16 | $1,653.54 | |
Health Net Blue & Gold | Employee Cost | $69.89 | $125.80 | $208.35 | $264.25 |
| UC Contribution | $600.70 | $1,081.26 | $1,199.89 | $1,680.45 | |
Kaiser Permanente | Employee Cost | $51.83 | $93.29 | $116.86 | $158.31 |
| UC Contribution | $535.03 | $963.05 | $1,115.55 | $1,543.58 | |
UC Care | Employee Cost | $150.97 | $271.75 | $378.63 | $499.40 |
| UC Contribution | $600.70 | $1,081.26 | $1,199.89 | $1,680.45 | |
Western Health Advantage | Employee Cost | $51.83 | $93.29 | $116.86 | $158.31 |
| UC Contribution | $525.98 | $946.77 | $1,096.55 | $1,517.34 | |
Core | Employee Cost | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | $235.87 | $424.57 | $495.33 | $684.02 | |
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate. | |||||