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<br /> <br /> <br /> <br /> September 5, 2024 E-1 <br />PREMIUMS <br /> <br />Retiree Premiums – Non Medicare Eligible <br />7/1/23– 6/30/24 <br /> <br /> <br />Version 1 <br />PCEA (DOR<7/1/12), <br />IAFF (DOR<1/1/08), <br />POA & Mgmt/Conf <br />(DOR<7/1/09) <br />Version 212 <br />PCEA (DOR>7/1/12), <br />IAFF (DOR>1/1/08), <br />POA & Mgmt/Conf <br />(DOR>7/1/09) <br />Plan Single 2-Party Family Single 2-Party Family <br />Kaiser $848.43 $1,696.85 $2,256.82 $826.58 $1,653.17 $2,198.71 <br />HealthNet HMO 1,955.46 3,661.07 5,119.60 1,901.53 3,708.72 4,986.93 <br />HealthNet PPO 1,978.87 4,254.63 5,324.91 1,962.46 4,219.35 5,279.12 <br />HealthNet Smart <br />Care 1,386.88 2,981.80 4,091.29 1,386.88 2,981.80 4,091.29 <br /> <br /> <br />12 Same as active premiums. <br /> <br /> <br /> <br /> <br /> September 5, 2024 E-2 <br />PREMIUMS <br />Premiums – Medicare Eligible <br />7/1/23 – 6/30/24 <br /> <br /> <br />Version 1 <br />PCEA (DOR<7/1/12), <br />IAFF (DOR<1/1/08), <br />POA & Mgmt/Conf <br />(DOR<7/1/09) <br />Version 2 <br />PCEA (DOR>7/1/12), <br />IAFF (DOR>1/1/08), <br />POA & Mgmt/Conf <br />(DOR>7/1/09) <br />Plan Single 2-Party Single 2-Party <br />Kaiser Sr. Advantage $389.21 $778.42 $282.89 $565.79 <br />Health Net HMO 1,287.57 2,575.14 1,287.57 2,575.14 <br />Health Net PPO 1,391.24 2,782.48 1,391.24 2,782.48 <br />Health Net Senior Plus <br />PPO 352.63 705.26 352.63 705.26 <br /> <br />