LAPRA Retiree 2018-2019 Medical & Dental Premium Rates

1 LAPRA Retiree 2018-2019 Medical & Dental Premium Rates Anthem Blue Cross PPO and CaliforniaCare HMO Premium Rates The tables on pages 1 and 2 reflect the retiree monthly premium rates under the Anthem Blue Cross PPO and CaliforniaCare HMO plans effective July 1, 2018. Your cost is the monthly premium rate minus the Pension Department subsidy, based on your retirement date, age and years of service. Anthem Blue Cross Monthly Premium Rates (07/01/18 - 06/30/19) Office Use Only Coverage Tier PPO HMO (CA Residents Only) 10 Single - Retired No Medicare $970.75 $949.89 11 2 Party - Retired No Medicare $2,164.21 $1,844.61 12 Family - Retired No Medicare $2,535.44 $2,160.59 20 Member B&D $782.75 $842.89 20a Member B Only $820.75 $871.89 21 2 Party: Member B&D; Spouse A&B&D $1,603.21 $1,500.61 21a 2 Party: Member B&D; Spouse A&B $1,641.21 $1,529.61 21b 2 Party: Member B; Spouse A&B&D $1,641.21 $1,529.61 21c 2 Party: Member B; Spouse A&B $1,679.21 $1,558.61 22 2 Party: Member None; Spouse A&B&D $1,791.21 $1,607.61 22a 2 Party: Member None; Spouse A&B $1,829.21 $1,636.61 23 2 Party: Member B&D; Spouse B&D $1,788.21 $1,630.61 23a 2 Party: Member B&D; Spouse B $1,826.21 $1,659.61 23b 2 Party: Member B; Spouse B&D $1,826.21 $1,659.61 23c 2 Party: Member B; Spouse B $1,864.21 $1,688.61 24 2 Party: Member None; Spouse B&D $1,976.21 $1,737.61 24a 2 Party: Member None; Spouse B $2,014.21 $1,766.61 25 2 Party: Member B&D; Spouse None $1,976.21 $1,737.61 25a 2 Party: Member B; Spouse None $2,014.21 $1,766.61 26 3 Party: Member B&D; Spouse None; Deps None $2,347.44 $2,053.59 26a 3 Party: Member B; Spouse None; Deps None $2,385.44 $2,082.59 26b 3 Party: Member B&D; Spouse B&D; Deps None $2,159.44 $1,946.59 27 3 Party: Member None; Spouse A&B&D; Deps None $2,162.44 $1,923.59 27a 3 Party: Member None; Spouse A&B; Deps None $2,200.44 $1,952.59 28 2 Party: Member B&D; Spouse A&D $1,753.21 $1,578.61 29 3 Party: Member None; Spouse None; Deps A&B&D $2,162.44 $1,923.59 29a 3 Party: Member None; Spouse None; Deps A&B $2,200.44 $1,952.59 30 Member Only A&B&D $597.75 $712.89 30a Member Only A&B $635.75 $741.89 31 2 Party: Member A&B&D; Spouse None $1,791.21 $1,607.61 31a 2 Party: Member A&B; Spouse None $1,829.21 $1,636.61 31b 2 Party: Member A&B&D; Spouse A&D $1,568.21 $1,448.61 31c 2 Party: Member A&B&D; Spouse A $1,606.21 $1,477.61 31d 2 Party: Member A&B; Spouse A&D $1,606.21 $1,477.61 31e 2 Party: Member A&B; Spouse A $1,644.21 $1,506.61 32 2 Party: Member A&B&D; Spouse B&D $1,603.21 $1,500.61 32a 2 Party: Member A&B&D; Spouse B $1,641.21 $1,529.61 32b 2 Party: Member A&B; Spouse B&D $1,641.21 $1,529.61 32c 2 Party: Member A&B; Spouse B $1,679.21 $1,558.61 33 2 Party: Both A&B&D $1,418.21 $1,370.61 33a 2 Party: Member A&B; Spouse A&B&D $1,456.21 $1,399.61 33b 2 Party: Member A&B&D; Spouse A&B $1,456.21 $1,399.61 33c 2 Party: Both A&B $1,494.21 $1,428.61 33d 2 Party: Member A&D; Spouse A&B&D $1,568.21 $1,448.61 33e 2 Party: Member A Only; Spouse A&B&D $1,606.21 $1,477.61 33f 2 Party: Member A/D ; Spouse A/B $1,606.21 $1,477.61 34 3 Party: Member A&B&D; Spouse None; Deps None $2,162.44 $1,923.59