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<br /> <br /> <br /> <br /> September 5, 2024 E-3 <br />PREMIUMS <br />Retiree Premiums – Non Medicare Eligible <br />7/1/24– 6/30/25 <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 213 <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 $942.53 $1,885.07 $2,507.14 $918.85 $1,837.70 $2,444.14 <br />HealthNet HMO 2,168.61 4,060.14 5,677.65 2,108.80 4,112.98 5,530.51 <br />HealthNet PPO 2,194.57 4,718.38 5,905.33 2,176.37 4,679.26 5,854.55 <br />HealthNet Smart <br />Care 1,538.05 3,306.82 4,537.24 1,538.05 3,306.82 4,537.24 <br /> <br /> <br />13 Same as active premiums. <br /> <br /> <br /> <br /> <br /> September 5, 2024 E-4 <br />PREMIUMS <br />Premiums – Medicare Eligible <br />7/1/24 – 6/30/25 <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 $440.72 $881.44 $330.20 $660.40 <br />Health Net HMO 1,372.57 2,745.14 1,372.57 2,745.14 <br />Health Net PPO 1,476.24 2,952.48 1,476.24 2,952.48 <br />Health Net Senior Plus <br />PPO 370.26 740.52 370.26 740.52 <br /> <br />