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<br /> <br /> <br /> <br />October 13, 2022 E-3 <br />PREMIUMS <br />Retiree Premiums – Non Medicare Eligible <br />7/1/21– 6/30/22 <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 215 <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 $797.36 $1,594.72 $2,120.98 $775.27 $1,550.54 $2,062.21 <br />HealthNet HMO 1,661.11 3,109.98 4,348.96 1,615.30 3,150.45 4,236.26 <br />HealthNet PPO 1,681.00 3,614.20 4,523.38 1,667.06 3,584.22 4,484.46 <br />HealthNet Smart <br />Care 1,178.12 2,532.96 3,475.45 1,178.12 2,532.96 3,475.45 <br /> <br /> <br /> <br />15 Same as active premiums. <br /> <br /> <br /> <br /> <br />October 13, 2022 E-4 <br />PREMIUMS <br />Premiums – Medicare Eligible <br />7/1/21 – 6/30/22 <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 $443.35 $886.70 $337.10 $674.21 <br />Health Net HMO 1,109.56 2,219.12 1,109.56 2,219.12 <br />Health Net PPO 1,200.00 2,400.00 1,200.00 2,400.00 <br /> <br />