2004 Health Plan Rates
for Staff / Faculty / MPP
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Page Last Revised on
06/30/2004
Staff/Faculty/MPP (except Unit 6) ♦
Unit 6 ♦
CalPERS Health
Plan Rates Page ♦
Units 1, 2, 3, 4, 5, 7, 8, 9, C99, M80 Printable Version (Excel)
| Gross | University | Employee | |||
| Health Plan Name | Plan Code | Premium | Contribution | Cost/ mo. | |
| Blue Shield | |||||
| Employee only | 2051 | $315.22 | $315.22 | $0.00 | |
| Employee & 1 dep. | 2052 | $630.44 | $621.00 | $9.44 | |
| Employee & 2 or | 2053 | $819.57 | $780.00 | $39.57 | |
| more dependents | |||||
| Kaiser | |||||
| Employee only | 561 | $305.42 | $305.42 | $0.00 | |
| Employee & 1 dep. | 562 | $610.84 | $610.84 | $0.00 | |
| Employee & 2 or | 563 | $794.09 | $780.00 | $14.09 | |
| more dependents | |||||
| PERS - Care (PPO) | |||||
| Employee only | 2781 | $544.77 | $331.00 | $213.77 | |
| Employee & 1 dep. | 2782 | $1,089.54 | $621.00 | $468.54 | |
| Employee & 2 or | 2783 | $1,416.40 | $780.00 | $636.40 | |
| more dependents | |||||
| PERS - Choice (PPO) | |||||
| Employee only | 2221 | $349.41 | $331.00 | $18.41 | |
| Employee & 1 dep. | 2222 | $698.82 | $621.00 | $77.82 | |
| Employee & 2 or | 2223 | $908.47 | $780.00 | $128.47 | |
| more dependents | |||||
Unit 6 Printable Version (Excel)