2004 UC Health Plan Rates
EMPLOYER CONTRIBUTION
(monthly)
|
Health Net |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employer premium for salaries of $40,000 or less |
247.65 |
445.78 |
520.06 |
718.20 |
|
Employer premium for salaries of $40,001 - $80,000 |
234.67 |
422.41 |
479.66 |
667.39 |
|
Employer premium for salaries of $80,001 - $120,000 |
220.53 |
396.97 |
436.61 |
613.04 |
|
Employer premium for salaries over $120,000 |
204.53 |
368.17 |
403.01 |
566.64 |
|
Kaiser Permanente – CA |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employer premium for salaries of $40,000 or less |
234.33 |
421.80 |
492.10 |
679.55 |
|
Employer premium for salaries of $40,001 - $80,000 |
225.04 |
405.08 |
467.02 |
647.10 |
|
Employer premium for salaries of $80,001 - $120,000 |
215.83 |
388.50 |
442.00 |
614.78 |
|
Employer premium for salaries over $120,000 |
199.83 |
359.70 |
408.40 |
568.38 |
|
PacifiCare of California |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employer premium for salaries of $40,000 or less |
229.72 |
413.50 |
482.40 |
666.17 |
|
Employer premium for salaries of $40,001 - $80,000 |
216.17 |
389.10 |
440.80 |
613.71 |
|
Employer premium for salaries of $80,001 - $120,000 |
201.37 |
362.48 |
396.37 |
557.46 |
|
Employer premium for salaries over $120,000 |
185.37 |
333.68 |
362.77 |
511.06 |
|
Blue Cross PLUS |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employer premium for salaries of $40,000 or less |
274.26 |
493.68 |
575.95 |
795.38 |
|
Employer premium for salaries of $40,001 - $80,000 |
264.21 |
475.58 |
541.69 |
753.07 |
|
Employer premium for salaries of $80,001 - $120,000 |
248.40 |
447.15 |
495.15 |
693.89 |
|
Employer premium for salaries over $120,000 |
232.40 |
418.35 |
461.55 |
647.49 |
|
Blue Cross PPO |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employer premium for salaries of $40,000 or less |
324.33 |
583.78 |
681.08 |
940.54 |
|
Employer premium for salaries of $40,001 - $80,000 |
308.24 |
554.81 |
634.14 |
880.71 |
|
Employer premium for salaries of $80,001 - $120,000 |
289.21 |
520.58 |
580.83 |
812.20 |
|
Employer premium for salaries over $120,000 |
273.21 |
491.78 |
547.23 |
765.80 |
|
CORE Major Medical - CA |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employer premium for salaries of $40,000 or less |
48.00 |
86.00 |
99.00 |
137.00 |
|
Employer premium for salaries of $40,001 - $80,000 |
48.00 |
86.00 |
99.00 |
137.00 |
|
Employer premium for salaries of $80,001 - $120,000 |
48.00 |
86.00 |
99.00 |
137.00 |
|
Employer premium for salaries over $120,000 |
134.24 |
241.62 |
308.40 |
415.78 |
|
|
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
DELTA DENTAL |
33.30 |
67.43 |
62.08 |
110.08 |
|
PMI DENTAL |
19.43 |
33.58 |
33.35 |
47.42 |
|
VISION SERVICE PLAN |
13.47 |
13.47 |
13.47 |
13.47 |
|
LEGAL PLAN (ARAG) |
0.00 |
0.00 |
0.00 |
0.00 |
2004 UC Health Plan Rates
EMPLOYEE PREMIUMS (monthly)
|
Health Net |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employee premium for salaries of $40,000 or less |
12.29 |
22.12 |
25.81 |
35.62 |
|
Employee premium for salaries of $40,001 - $80,000 |
25.27 |
45.49 |
66.21 |
86.43 |
|
Employee premium for salaries of $80,001 - $120,000 |
39.41 |
70.93 |
109.26 |
140.78 |
|
Employee premium for salaries over $120,000 |
55.41 |
99.73 |
142.86 |
187.18 |
|
Kaiser Permanente – CA |
Single |
Adult + Child(ren) |
Two Adults |
Family |
|
Employee premium for salaries of $40,000 or less |
3.50 |
6.30 |
7.35 |
10.15 |