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<br /> <br /> <br /> <br /> October 13, 2022 7 <br />BENEFIT SUMMARY <br /> <br />35 40 45 50 55 60 64 <br />Cost by Age 1,102 1,236 1,443 1,723 2,014 2,372 2,790 <br />Retiree Version 1 Premium 1,815 1,815 1,815 1,815 1,815 1,815 1,815 <br />Retiree Version 2 Premium 1,800 1,800 1,800 1,800 1,800 1,800 1,800 <br /> $- <br /> $500 <br /> $1,000 <br /> $1,500 <br /> $2,000 <br /> $2,500 <br /> $3,000 <br />$C <br />o <br />s <br />t <br />/ <br />P <br />r <br />e <br />m <br />i <br />u <br />m <br />Age <br />2022/23 Health Net PPO Plan - Single Coverage <br /> <br /> <br /> <br /> <br /> October 13, 2022 8 <br />BENEFIT SUMMARY <br />This page intentionally blank <br /> <br />