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<br /> <br /> <br /> <br />October 13, 2022 E-5 <br />PREMIUMS <br />Retiree Premiums – Non Medicare Eligible <br />7/1/20– 6/30/21 <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 216 <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 $804.38 $1,608.76 $2,139.65 $781.04 $1,562.07 $2,077.55 <br />HealthNet HMO 1,552.44 2,906.52 4,064.45 1,509.63 2,944.35 3,958.19 <br />HealthNet PPO 1,571.03 3,377.76 4,227.46 1,558.00 3,349.76 4,191.08 <br />HealthNet Smart <br />Care 1,101.05 2,367.25 3,248.08 1,101.05 2,367.25 3,248.08 <br /> <br /> <br />16 Same as active premiums. <br /> <br /> <br /> <br /> <br />October 13, 2022 E-6 <br />PREMIUMS <br />Premiums – Medicare Eligible <br />7/1/20 – 6/30/21 <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 $472.33 $944.66 $365.80 $731.60 <br />Health Net HMO 1,029.68 2,059.35 1,029.68 2,059.35 <br />Health Net PPO 1,130.23 2,260.47 1,130.23 2,260.47 <br /> <br />