The monthly costs for medical coverage below apply to retirees eligible for 100 percent of the UC/employer contribution toward the premium for each plan. If you are subject to graduated eligibility and, therefore, not eligible for the maximum UC/employer contribution, your costs may be higher than those listed below. Your plan cost appears as a deduction on your UCRP benefit direct deposit statement or check.
When all family members are in Medicare
| Medicare Plan | Self in Medicare |
Self + Adult or Self + Child(ren) Both in Medicare |
Self + Adult + Child(ren) All in Medicare |
|
|---|---|---|---|---|
| Health Net Seniority Plus |
Your Premium |
$76.66 | $153.32 | $229.98 |
| UC Contribution | $361.34 | $722.68 | $1084.02 | |
| Medicare Part B Reimbursement |
$0.00 | $0.00 | $0.00 | |
| Kaiser Permanente/ Senior Advantage |
Your Premium | $0.00 | $0.00 | $0.00 |
| UC Contribution | $268.76 | $537.52 | $806.28 | |
| Medicare Part B Reimbursement |
$92.58 | $185.16 | $277.74 | |
| UC High Option Supplement to Medicare |
Your Premium | $126.66 | $253.32 | $379.98 |
| UC Contribution | $361.34 | $722.68 | $1084.02 | |
| Medicare Part B Reimbursement |
$0.00 | $0.00 | $0.00 | |
| UC Medicare PPO | Your Premium | $39.66 | $79.32 | $118.98 |
| UC Contribution | $361.34 | $722.68 | $1084.02 | |
| Medicare Part B Reimbursement |
$0.00 | $0.00 | $0.00 | |
| UC Medicare PPO without Prescription Drugs | Your Premium | $0.00 | $0.00 | $0.00 |
| UC Contribution | $193.00 | $386.00 | $579.00 | |
| Medicare Part B Reimbursement |
$134.00 | $268.00 | $402.00 |
Medicare Part B reimbursement may apply if your premium cost is $0.00. Part B reimbursement is based on a Medicare Part B premium of $134.00 per person. Reimbursements vary and are added automatically to your monthly retirement payment.
When one or more family members are not Medicare eligible
| Non-Medicare/ Medicare Plans |
Self + Adult 1 Adult in Medicare |
Self + Child(ren) Adult in Medicare |
Self + Adult + Child(ren) 1 Adult in Medicare |
Self + Adult + Child(ren) 2 Adults in Medicare |
|
|---|---|---|---|---|---|
| Core/ UC Medicare PPO |
Your Premium | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | $604.50 | $549.00 | $752.50 | $950.00 | |
| Medicare Part B Reimbursement |
$134.00 | $134.00 | $134.00 | $164.22 | |
| Health Net Blue & Gold/ Seniority Plus |
Your Premium | $384.53 | $269.83 | $577.71 | $346.50 |
| UC Contribution | $866.21 | $759.25 | $1,264.13 | $1,120.59 | |
| Medicare Part B Reimbursement |
$0.00 | $0.00 | $0.00 | $0.00 | |
| Kaiser Permanente/ Senior Advantage |
Your Premium | $74.91 | $0 | $166.00 | $0.00 |
| UC Contribution | $788.09 | $700.94 | $1,129.18 | $969.70 | |
| Medicare Part B Reimbursement |
$0.00 | $1.50 | $0.00 | $94.07 | |
| UC Care/ UC Medicare PPO |
Your Premium | $420.91 | $286.20 | $667.45 | $325.86 |
| UC Contribution | $1,045.99 | $890.00 | $1,574.65 | $1,251.34 | |
| Medicare Part B Reimbursement |
$0.00 | $0.00 | $0.00 | $0.00 |
Medicare Part B reimbursement may apply if your premium cost is $0.00. Part B reimbursement is based on a Medicare Part B premium of $134.00 per person. Reimbursements vary and are added automatically to your monthly retirement payment.
Non-Medicare Plans
| Plan | Self | Self + Child(ren) | Self + Adult | Self + Adult + Child(ren) | |
|---|---|---|---|---|---|
| Core | Your Premium | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | $185.00 | $333.00 | $388.50 | $536.50 | |
| Health Net Blue & Gold | Your Premium | $241.47 | $434.64 | $549.34 | $742.52 |
| UC Contribution | $497.39 | $895.30 | $1,002.26 | $1,400.18 | |
| Kaiser Permanente — California | Your Premium | $113.85 | $204.93 | $281.34 | $372.43 |
| UC Contribution | $426.37 | $767.47 | $853.12 | $1,194.21 | |
| UC Care | Your Premium | $308.17 | $554.71 | $689.42 | $935.96 |
| UC Contribution | $660.83 | $1,189.49 | $1,345.48 | $1,874.14 | |
| UC Health Savings Plan | Your Premium | $141.34 | $254.41 | $339.07 | $452.14 |
| UC Contribution | $321.66 | $578.99 | $633.23 | $890.56 | |
| Western Health Advantage | Your Premium | $128.92 | $232.06 | $312.99 | $416.15 |
| UC Contribution | $601.81 | $1,083.25 | $1,221.54 | $1,702.97 |
Non-Medicare Plans Age 65 and over, NOT Medicare eligible
| Plan | Self | Self + Child(ren) | Self + Adult | Self + Adult + Child(ren) | |
|---|---|---|---|---|---|
| Core | Your Premium | $0.00 | $0.00 | $0.00 | $0.00 |
| UC Contribution | $185.00 | $333.00 | $388.50 | $536.50 | |
| Health Net Blue & Gold | Your Premium | $75.62 | $136.11 | $225.08 | $285.58 |
| UC Contribution | $663.24 | $1,193.83 | $1,326.52 | $1,857.12 | |
| Kaiser Permanente — California | Your Premium | $55.02 | $99.04 | $123.85 | $167.85 |
| UC Contribution | $485.20 | $873.36 | $1,010.61 | $1,398.79 | |
| UC Care | Your Premium | $142.32 | $256.18 | $365.16 | $479.02 |
| UC Contribution | $826.68 | $1,488.02 | $1,669.74 | $2,331.08 | |
| UC Health Savings Plan | Your Premium | $55.88 | $100.59 | $125.74 | $170.43 |
| UC Contribution | $407.12 | $732.81 | $846.56 | $1,172.27 | |
| Western Health Advantage | Your Premium | $55.83 | $100.49 | $125.62 | $170.26 |
| UC Contribution | $674.90 | $1,214.82 | $1,408.91 | $1,948.86 |