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<br /> <br /> <br /> <br />October 13, 2022 E-1 <br />PREMIUMS <br />Retiree Premiums – Non Medicare Eligible <br />7/1/22– 6/30/23 <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 214 <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 $787.55 $1,575.10 $2,094.88 $766.67 $1,533.36 $2,039.35 <br />HealthNet HMO 1,794.00 3,358.78 4,696.88 1,744.52 3,402.49 4,574.16 <br />HealthNet PPO 1,815.48 3,903.34 4,885.25 1,800.42 3,870.96 4,843.22 <br />HealthNet Smart <br />Care 1,272.37 2,735.60 3,753.49 1,272.37 2,735.60 3,753.49 <br /> <br /> <br />14 Same as active premiums. <br /> <br /> <br /> <br /> <br />October 13, 2022 E-2 <br />PREMIUMS <br />Premiums – Medicare Eligible <br />7/1/22 – 6/30/23 <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 $421.48 $842.96 $315.10 $630.03 <br />Health Net HMO 1,203.05 2,406.10 1,203.05 2,406.10 <br />Health Net PPO 1,282.85 2,565.70 1,282.85 2,565.70 <br />Health Net Senior Plus <br />PPO 337.38 674.76 337.38 674.76 <br /> <br />