San Benito County 2018 Contribution Rate Sheet Effective: January 1, 2018 Plan by Tier Active and Early Retiree Rates EIA Kaiser HMO Single Two Party Family EIA Anthem SAFETY PPO Single Two Party Family EIA Anthem PPO MID Single Two Party Family EIA Anthem HDHP Single Two Party Family Under 65 Non-Medicare Employee/Retiree/Over 65 non-Medicare Employee/Retiree, Medicare Dependent(s) Kaiser HMO Retiree (1 Medicare, 1 Without) Retiree (1 Medicare, 2 Without) Retiree (2 Medicare, 1 Without) EIA Anthem PPO Mid Retiree (1 Medicare, 1 Without) Retiree (1 Medicare, 2 Without) Retiree (2 Medicare, 1 Without) Under 65 Medicare Employee/Retiree, Non-Medicare Dependent(s) Kaiser HMO Retiree (1 Medicare, 1 Without) Retiree (1 Medicare, 2 Without) Retiree (2 Medicare, 1 Without) EIA Anthem PPO Mid Retiree (1 Medicare, 1 Without) Retiree (1 Medicare, 2 Without) Retiree (2 Medicare, 1 Without) Over 65 Medicare Employee/Retiree, Non-Medicare Dependent(s) Kaiser HMO Retiree (1 Medicare, 1 Without) Retiree (1 Medicare, 2 Without) Retiree (2 Medicare, 1 Without) EIA Anthem PPO Mid Retiree (1 Medicare, 1 Without) Retiree (1 Medicare, 2 Without) Retiree (2 Medicare, 1 Without)
Medical Contributions - Active Rates
BiWeekly (24 Pay Period) Cost
Carrier Rates
County Contribution
Employee Share
Employee Share
$764.00 $1,513.00 $1,963.00
$550.00 $1,050.00 $1,315.00
$214.00 $463.00 $648.00
$107.00 $231.50 $324.00
$675.00 $1,351.00 $1,726.00
$550.00 $1,050.00 $1,315.00
$125.00 $301.00 $411.00
$62.50 $150.50 $205.50
$768.00 $1,536.00 $1,996.00
$550.00 $1,050.00 $1,315.00
$218.00 $486.00 $681.00
$109.00 $243.00 $340.50
$699.00 $1,397.00 $1,816.00
$550.00 $1,050.00 $1,315.00 Medical Contribution - Split Rates
$149.00 $347.00 $501.00
$74.50 $173.50 $250.50
Carrier Rates
County Contribution
Employee/Retiree Share
Employee/Retiree Share
Pending $1,050.00 $1,491.00 $1,058.00
$1,050.00 $1,315.00 $1,058.00
$0.00 $176.00 $0.00
$0.00 $88.00 $0.00
$1,171.00 $1,631.00 $1,265.00
$1,050.00 $1,315.00 $1,265.00
$60.50 $158.00 $0.00
Carrier Rates
County Contribution
Pending $1,050.00 $1,491.00 $1,058.00
$121.00 $316.00 $0.00 Employee/Retiree Share
$1,050.00 $1,315.00 $1,058.00
$0.00 $176.00 $0.00
$0.00 $88.00 $0.00
$1,171.00 $1,631.00 $1,265.00
$1,050.00 $1,315.00 $1,265.00
$121.00 $316.00 $0.00
$60.50 $158.00 $0.00
Pending $1,050.00 $1,491.00 $1,058.00
$735.00 $920.50 $920.50
$315.00 $570.50 $137.50
$157.50 $285.25 $68.75
$1,171.00 $1,631.00 $1,265.00
$735.00 $920.50 $920.50
$436.00 $710.50 $344.50
$218.00 $355.25 $172.25
Medical Contribution - Retiree Rates (County Contribution 70% of Active)
Over 65 Medicare Retiree Medicare Rates KPSA (EIA Health) Single Two Party Family EIA Anthem PPO MID SUPP EGWP Single Two Party Family
Carrier Rates Pending $316.00 $617.00 $917.00
County Contribution
Retiree Share
Retiree Share
$316.00 $617.00 $917.00
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$403.00 $805.00 $1,207.00
$385.00 $735.00 $920.50
$18.00 $70.00 $286.50
$9.00 $35.00 $143.25
Medical Contribution - Retiree Rates (County Contribution 100% of Active)
Under 65 Medicare / Over 65 Non-Medicare Retiree Medicare Rates KPSA (EIA Health) Single Two Party Family EIA Anthem PPO MID SUPP EGWP Single Two Party Family
Employee/Retiree Share
Carrier Rates
County Contribution
Retiree Share
Retiree Share
Pending $316.00 $617.00 $917.00
$316.00 $617.00 $917.00
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
$403.00 $805.00 $1,207.00
$403.00 $805.00 $1,207.00
$0.00 $0.00 $0.00
$0.00 $0.00 $0.00
Ancillary Contributions Actives Delta Dental (CSAC EIA) PPO Single Two Party Family MES Vision (CSAC EIA) Single Two Party Family
Carrier Rates
County Contribution
Employee Share
Employee Share
$46.70 $80.10 $130.80
$30.00 $30.00 $30.00
$16.70 $50.10 $100.80
$8.35 $25.05 $50.40
$5.35 $10.70 $13.80
$5.35 $5.35 $5.35
$0.00 $5.35 $8.45
$0.00 $2.68 $4.23
San Benito County 2018 Contribution Rate Sheet Effective: January 1, 2018 Plan by Tier
Medical Contributions
BiWeekly (24 Pay Period) Cost
Part-Time Employees (0.50 FTE) EIA Kaiser HMO Single Two Party Family EIA Anthem SAFETY PPO Single Two Party Family EIA Anthem PPO MID Single Two Party Family EIA Anthem HDHP Single Two Party Family
Carrier Rates
County Contribution
Employee Share
Employee Share
$764.00 $1,513.00 $1,963.00
$275.00 $525.00 $657.50
$489.00 $988.00 $1,305.50
$244.50 $494.00 $652.75
$675.00 $1,351.00 $1,726.00
$275.00 $525.00 $657.50
$400.00 $826.00 $1,068.50
$200.00 $413.00 $534.25
$768.00 $1,536.00 $1,996.00
$275.00 $525.00 $657.50
$493.00 $1,011.00 $1,338.50
$246.50 $505.50 $669.25
$699.00 $1,397.00 $1,816.00
$275.00 $525.00 $657.50
$424.00 $872.00 $1,158.50
$212.00 $436.00 $579.25
Part-Time Employees (0.50 FTE) Delta Dental (CSAC EIA) PPO Single Two Party Family
Carrier Rates
County Contribution
Employee Share
Employee Share
$46.70 $80.10 $130.80
$15.00 $15.00 $15.00
$31.70 $65.10 $115.80
$15.85 $32.55 $57.90
Ancillary Contributions
San Benito County 2018 Contribution Rate Sheet Effective: January 1, 2018 Plan by Tier
Medical Contributions
BiWeekly (24 Pay Period) Cost
Part-Time Employees (0.75 FTE) EIA Kaiser HMO Single Two Party Family EIA Anthem SAFETY PPO Single Two Party Family EIA Anthem PPO MID Single Two Party Family EIA Anthem HDHP Single Two Party Family
Carrier Rates
County Contribution
Employee Share
Employee Share
$764.00 $1,513.00 $1,963.00
$412.50 $787.50 $986.25
$351.50 $725.50 $976.75
$175.75 $362.75 $488.38
$675.00 $1,351.00 $1,726.00
$412.50 $787.50 $986.25
$262.50 $563.50 $739.75
$131.25 $281.75 $369.88
$768.00 $1,536.00 $1,996.00
$412.50 $787.50 $986.25
$355.50 $748.50 $1,009.75
$177.75 $374.25 $504.88
$699.00 $1,397.00 $1,816.00
$412.50 $787.50 $986.25
$286.50 $609.50 $829.75
$143.25 $304.75 $414.88
Part-Time Employees (0.75 FTE) Delta Dental (CSAC EIA) PPO Single Two Party Family
Carrier Rates
County Contribution
Employee Share
Employee Share
$46.70 $80.10 $130.80
$22.50 $22.50 $22.50
$24.20 $57.60 $108.30
$12.10 $28.80 $54.15
Ancillary Contributions
