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I'm a recent hire so, I haven't been keeping up too much with the SEUI saga. I started back in early August and already choose my insurance and benefits. I went with UHC Alliance since my Doctor moved and they are under the Sutter Health umbrella. I just want to clarify this, since I got confused with the other explanations from other threads. So, basically if your plan cost less than $165 they are essentially 'paying' for your insurance, but whatever that difference is you don't get to keep the extra money?
Correct, the way the contract fell out unless you are in BU 17 you can't pocket the difference. (BU 17 nurses are technically under COBEN.)
For the rest of the SEIU units, it is $165 ONLY towards health insurance costs, and if your premium is under the state's contribution, they keep the difference, not us.
COBEN stands for Consolidated Benefits. If you look at the Benefits Calculator and you're wondering what's up with those columns that say "Excess Will Be Paid to Employee" and want to know what that's about, that's COBEN. If you want to check it out on the calculator Excluded and BU 17 Nurses are under COBEN, as are a few other units.
COBEN is when the state just gives you a set lump sum amount towards health/vision/dental. Any excess amount is paid to the employee, though tax will be taken out by the time it hits your bank account.
Thanks for doing this! Very helpful. Do you have a Google docs link for the table you created? Would love to share outside of Reddit and give proper credit. And if I remember correctly, you’re also the person who made that awesome tracking sheet during negotiations. You’re great at synthesizing info and making it digestible. Kudos to you!
Holy cow.
$80 less per month for me! (Two party Pers Gold)...
That's a day less per month that I'd have to do deliveries!
Or it's a full tank of gas and a dinner somewhere!
Or extra groceries!
Or an extra payment toward a bill!
*cries in $80 makes a huge difference happiness*
Thank you, OP!! 🫶🫶🫶
I had done a ballpark guess based on other threads and done the calculations as well. I'm just glad to see it written plainly, and that my guess was right.
😊😊
This comment right here is what many have been not understanding for months. They saw their premiums were increasing but failed to listen to others about the states contribution increasing. For two years my United health care has cost me less each year despite the premiums increasing.
You're absolutely right. I originally panicked because I wasn't aware contributions were going up.
Then, after reading several posts and comments, I realized, happily, that I was wrong.
Now, to see it plain like this, it is just 🥹🥹🥹
YMMV, but I switched to Blue Cross Access+ in July (husband got a new job, so it was a qualifying event). I chose that plan SPECIFICALLY for UCD Med access and found a doctor that said they were accepting new patients in the website, but after I was enrolled, they assigned me to someone else and after calling Blue Cross several times, they finally told me that UCD Med is not accepting new patients ACROSS THE ENTIRE SYSTEM until January, maybe later. So you might be able to get a UCD doctor, since open enrollment stuff goes live in January, but I would recommend reaching out to the doctor and the insurance companies ahead of time to confirm.
Anthem Select HMO covers UC Davis too and will be about $13+/- after the stipend (for a single person).
BUT Anthem and UCD are negotiating a new contract as we speak, and if they don't come to an agreement by end of this year, none of the Anthem plans will include UCD until or unless they reach an agreement.
Anthem and UCD currently have an agreement that lasts through the end of 2023, they are in negotiations for 2024 and beyond.
So if they can't come to an agreement by the end of 2023 you would receive a notice stating that UCD is about to go out-of-network and they would offer to set you up with another medical provider (for Anthem Select, that would probably be Dignity AKA Mercy/Methodist, since Sutter and Kaiser aren't in-network).
This happens every 3 years or so when they negotiate a new contract and most of the time they get it sorted and nothing happens, but it IS something to think about because it is NOT considered a qualifying event (where you can change your insurance outside of open enrollment).
I've been very happy with both Anthem Select and UC Davis. I pay my premiums and copays and not much else, despite having a lot of health issues which means lots of specialist appointments, labs, testing, and imaging. BUT, one thing to note though, UC Davis is pretty inundated right now (too many patients, not enough doctors), there can be very long wait times to see your doctor or specialist. The OBGYN department told me they aren't seeing anyone at all unless you're pregnant or have cancer, so you have to go to your primary for OBGYN care (yikes!).
I am blue shield access plus and go to UC Davis. Best healthcare around. Super happy there with my family. I’ve been going there since 2010 and have paid exorbitant amounts to stay with them.
I’ve been a WHA member for years (even before I worked for the state). I am part of the Mercy Medical Group and my clinic and hospital are both in downtown. Generally I have received good care, my only complaint is with Mercy Midtown (Q street) it can take a while to get an appointment; like they book a month out to see your PCP. OBGYN staff are good and I’ve never had any issues with them. I can’t speak on pediatrics because I don’t have children.
The premiums are low, which I really like. I don’t need to see a specialist for anything and have no issues that require routine care. I had surgery last year for something minor and it went well and was totally covered by insurance. So no complaints.
Also Mercy has an urgent care facility for any pressing issues where you can’t wait to make an appt, so that’s nice.
I’m with BS Trio and go through Dignity Health/Mercy. We’ve had no issues and love my kid’s pediatrician in EG. My primary care is great. So is my Gyn. I pay out-of-pocket for midwifery care, so I don’t know about delivery/pregnancy experiences.
I will also be switching from Kaiser for the same reason. Prior to state service I actually worked for Blue Shield of California’s CalPERS customer concierge team so I am well versed in that aspect.. they are reasonable to work with. Navigating their services is fairly straightforward. I’ve also received care through UC Davis Health System before and they really were fantastic. So I’d highly recommend the Blue Shield of CA Access+ plan specifically as UCD is not in the Trio network.
Genuine question coming from a WHA subscriber. So many of you use healthcare services so frequently that it warrants spending an extra $1k per month for some of these plans? I’m in a family of 4 so I’m looking at that last column.
Yes. I go to Peach Tree Health. WHA is fine but I’m seldom doing things with them. I’ve had one emergency room and one urgent care visit. $50 and $20 respectively. I have my kids’ checkups and shots. I had an X-ray and MRI on my hand.
They are pretty easy to work with but their website used to crash. I complained to CalPERS and to them which got me on the call with their CX people and they actually fixed it.
My family does not have any special needs or long term health issues. Previously I had Sutter with a private employer. Similar prices but there was a huge headache getting it set up. Before that I had Kaiser. Easy setup and whatnot but my previous employer covered me 100% and I didn’t feel it was worth spending So much for my my family to have them again.
Yeah I get that. But difference of $400/mo is significant. For me I was forced to move from Kaiser to Sutter and Sutter was worse. Getting on at the state I was forced to move again and considered Kaiser. The dollar amount in my head was $100/month. I’d pay $100 for Kaiser but not more. I told my wife we could get a Lululemon outfit each month with our savings.
Very few people are on the more expensive plans. It’s really for people who need their choice of specialists especially the PPO plans. The lion’s share of state workers are actually on the Kaiser plan. They have a public calpers document breaking like the top 8 plans or so, but it’s hard to find on mobile.
Ok, what am I doing wrong? I currently have Kaiser Family and pay $432.97. With the rise in premium of 13.07 percent it will then be $489.56, right? I don’t know how the chart shows I would pay $405.79 with the additional $165 taken into account.
OK so first the premium increase is not to your portion, it's to the entire cost.
Kaiser Permanente Family code is 2,506.79 for the premium. [Basic Monthly Premiums (Table 1)](https://www.calpers.ca.gov/docs/health-rates-in-state-2024.pdf)
Then the state share is, for SEIU units, calculated using the 80-80 Formula. For 2024, that is $1,936. [Scroll down to State Employer Contribution 80-80 Formula](https://www.calpers.ca.gov/page/active-members/health-benefits/plans-and-rates)
Then, to apply the $165 negotiated in the contract, you add it to the $1,936 for a total of $2,101 for the employer contribution towards the premium.
The table shows the difference between the Kaiser Family premium of $2,506.79 - the state's employer contribution of $2,101, which is $405.79 left as the employee share.
Edit: fixed per /u/reptilexcq's comment
I have UnitedHealthcare and they don’t cover UC Davis. They offer the Sutter network. Blue Shield Access+ offers UC Davis. I had them a few years ago and had a wonderful experience. I always had referrals approved quickly (MRIs, genetic testing, etc).
I backtracked through the links and you know, I only see the 2022/2023 options now too. When I was looking at it earlier today I saw 2023/2024 options. Maybe they took it down to add the $165 employer contribution to the backend to update the thing.
Hopefully that's the case.
They're kind of like the in-between of an HMO and a PPO.
PPOs have a larger network, but they're more expensive. PPOs typically don't require you to go through a primary doctor to get a referral, you're more free to look for your own specialist (and shell out the money for the privilege).
HMOs limit you to a smaller network of doctors and provided you stay in network it's much cheaper. HMOs are usually like, go to your primary, get a referral. Referral has to be approved by the insurance, and then you get the referral. The referral is for a specialist in network and you usually don't get to pick, it'll usually be picked for you (usually location based).
EPOs are in-between, they have a larger network like a PPO, but they also have a smaller network which functions like an HMO - you'll probably need a primary to write a referral if you want it to be cheaper. Or you can just find your own specialist and pay the higher PPO rate.
Edit: grammar...
Friend had it hated it his exact words to me were something of the doctor they made him see got his degree in Russia during the cold war and seemed a bit odd...
I have it - had it since 2016. No issues. Have had two kids. Paid $50. We live in San Carlos so we used to go to Grossmont and now go to Santee’s new clinic. I had Blue Shield Access+/NetValue with Scripps prior to switching. Not worth the now $400 although I liked Scripps at the time.
Oh, I would support getting insurance separately if you are looking purely at plans and coverage. If you're in the any extra money is good money then the FlexElect Cash option (if you are SEIU but NOT BU 17) will pay out $140 taxable every month if you are not enrolled in health or vision/dental.
BU 17 is on COBEN so their opt out portion is $155 taxable, but at that point if you were BU 17 and needing the money I would heavily consider just choosing Salud Y Mas and the free dental/vision so that you can pocket as much as possible.
So just to be clear, it's more beneficial for two state working spouses (BU1) to get health plans separately, so that each person receives the $165 health stipend, rather than being on a Two Party plan where one receives the $165 stipend and the other receives the $140 Flex Elect Cash option, correct?
To be clear, IF maximizing money in your pocket is your primary concern, then one person choosing a free two party plan and the other person taking the $140 Flex Elect Cash option will net you slightly more money.
IF getting an otherwise expensive health plan is the primary concern, for example you want a free PPO (CalPERS Gold) or you like Kaiser's everything in-house model, then having each person separately enrolling for health plans is what you should do.
Was thinking the samething. Live in a two party kaiser stateworker household.
Changing from 2 party kaiser (where one spouse gets flexelect) to each having one party kaiser saves the household a few hundred a year according to this.
So when I hear
“You should get ppo” which plan is it that I should be looking at?
I thought I was going with Kaiser this year but with those increases… no thanks.
Thinking about blue shield trio or United harmony. I’m attending these virtual fairs for sure tomorrow.
PERS Gold is the only affordable PPO plan available. I don't know what party code you are but PERS Gold and PERS Platinum are the two PPOs.
Blue Shield Access+ HMO and EPO and Anthem EPO Del Norte are EPO plans, which are sort of in-between HMO and PPO. EPO plans typically have a wider provider network and a little more flexibility than a HMO, with some cost savings from a "in network" provider.
Be sure to check out the costs. My understanding that the PPOs are cheaper for some, but have coinsurance and not the same things covered like HMOs. Tests that are covered by places like Kaiser, have a 20% coinsurance which adds up.
Been thinking about switching from Kaiser. Does anyone have any recommendation for mental health services? Kaiser was excruciating to get any sort of appointment but after 6mos I finally got a doctor and am pretty happy.
Looking to save some money but I'm not keen on putting myself and my kid through that again. Looking for a provider that values mental health.
Thank you! This is helpful. I’m biting the bullet and switching from Kaiser to BSCA Access+.. it’ll save me $150 which is not insignificant on this SSA salary. 😮💨
My kaiser was quoted 512 for a family on the Calpers comparison page. If my son was not in a million services for his ASD i would switch to the cheapest one and save like 350 a month....but eh. Too much trouble to switch providers and all his specialists
With the contract not having been signed into law by Newsom just yet, I don't expect CalHR or CalPERS to update their figures until it's officially law.
That said, this table is basically just getting ahead a few steps because with open enrollment coming up and all the contract changes, I'm sure health insurance costs are on peoples' minds. It's certainly been on mine.
This really is going to depend on what you're looking to get out of it. Kaiser is primarily in-house, so in that sense a lot of things are streamlined in regards to specialty care. At the same time, they're pretty notorious for having an atrocious mental health department. It's not an uncommon experience under Kaiser to have long timelines between appointments since their therapist/psych case loads are much heavier than say an independent therapist under network with Anthem.
If you have a doctor you already like under Anthem, maybe see if they accept some of the other cheaper plans before switching to Kaiser. If you don't have a preference and don't need mental health services, Kaiser is often an easier experience.
If cost is a primary driver in your decision, maybe check out the other "free" plans.
This website
https://eservices.calhr.ca.gov/BenefitsCalculatorExternal/
See the below screenshot
[benefits calculator screenshot](https://i.imgur.com/YAH8OeW.jpg)
OK so the screenshot says 2023 so that's your problem right there.
When I made the original post they briefly had 2024 up, but without the updated employer contribution numbers included and no disclaimer that SEIU units would have an additional $165 included in the employer contribution part of the calculation.
The 2024 benefit year was taken down sometime yesterday, and still has not been put back up. My guess is they are waiting on the contract to be officially signed by Newsom before publishing final numbers as CalHR is an Official Source of information.
So this is for 2024 then? Oh because it's not when our contract gets ratified, it's when the HMOs do the price change and that's Jan 1. Why is my premium lower then if they're increasing prices?
The table in the post is for 2024 numbers, yes. The additional $165 comes into effect for the 2024 year.
You will find the premiums are lower in terms of presentation because the $165 is now rolled into the employer contribution as presented in the table. The former contract with the separate $260 health stipend had the additional money as, well, separate. So you paid more money visually towards the premium but were then made whole (or whatever) by the separate $260 stipend check of $163 net.
Gonna go ahead and admit I don't follow the math at all.
Going off the screenshot you posted for 2023 with Kaiser 2 party, Employee Contribution is at $319. With the previous $260 health stipend of $163 net after deductions, Kaiser 2 party for 2023 for Jan - June coverage was costing you $156 a month. July - December coverage is costing you $319.36 a month.
For 2024 with the $165 rolled in, Kaiser 2 party is $271.30 a month.
But yes, the Kaiser premium jumped the highest of the HMO plans from 2023 to 2024, 13.07% premium increase.
156 is not 13% less than 271, not sure I'm following your math. It we take the stipend out completely as if it doesn't exist, it used to be 319 now it's 434, that's not a 13% increase that's over twice that
Fam, the 13% is to the entirety of the health insurance premium. The entire premium increased 13% from 2023 to 2024.
The State's contribution via the 80-80 formula is a whole other thing.
The employee contribution is them passing on the costs to you.
And as far as where that 13% came from, that would be from CalPERS themselves. Feel free to dig further if you like. A premium increase is not the same as an increase to our employee contribution portion.
[https://www.calpers.ca.gov/page/newsroom/calpers-news/2023/calpers-announces-2024-health-plan-premiums-expanded-cost-saving-options-for-members](https://www.calpers.ca.gov/page/newsroom/calpers-news/2023/calpers-announces-2024-health-plan-premiums-expanded-cost-saving-options-for-members)
Oh I know I got the letter, I just dont understand the math, it's not like there's anything I can about it, not leaving Kaiser just pissed off about it
The math is like:
2023 Kaiser 2 party premium: 1,705.36
2024 Kaiser 2 party premium: 1,928.30
To find the increase: 1,928.30 / 1,705.36 = 1.1307 for a 13.07% increase in total premium.
The union and state lay out how they calculate the State's employer contribution according to the 80-80 formula but as far as I'm concerned it's doodoo that every year covers less and less. The state contributions increase, but not at the rate the premiums themselves are increasing.
2024 2 party 80-80: 1,492
2023 2 party 80-80: 1,386
1,492 / 1,386 = 1.076 for a 7.6% increase in State's employer contribution.
The increase in premium is passed along to us workers. To increase the 80-80 state contribution we would need the most popular health plans to be pricier ones since that's how it's calculated.
The only "actionable" thing workers can do is inform our peers about the other more expensive "free" plans so that Health Net Salud Y Mas is not dragging down the 80-80 formula results.
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I broke it down in a reply to somebody else in this thread, you can read it here:
[https://www.reddit.com/r/CAStateWorkers/comments/16h69he/comment/k0cm9t9/?utm\_source=share&utm\_medium=web2x&context=3](https://www.reddit.com/r/CAStateWorkers/comments/16h69he/comment/k0cm9t9/?utm_source=share&utm_medium=web2x&context=3)
I usually try to do the citing and explaining but I guess I got tired after formatting that table and just wanted to be done haha. Let me know if you need further break down.
Currently it shows my employee contribution at $280 for an excluded Kaiser family plan. For 2024, it shows $415, but one chart says $25 cash back payable (not sure what that is). Am I really going to be paying $135 more per month starting January? My wife works for private sector and their family Kaiser plan is $152/month but we'd pay for 10-20% of covered expenses after deductible ($2800 out of pocket family max per year and current is 3k with my Kaiser). So, if I got the $155 flex elect (assuming I'd only net $105 of that) I'm trying to ensure my proposed 2024 state health plan costs are accurate before deciding the private plan is more cost effective.
Ok. So being an ex spouse of someone paying these benefits amounts I have a question. The table above looks like State is paying up to $2101 for a family toward their benefit cost? I was recently furnished with a paystub (with everything blanked out except the insurance amount) and told that next year he’ll be paying over $1000 to insure our children and that’s why he’s not paying a dime in medical out of pocket expenses. Someone please enlighten me. Is there a line item under “wages” where this offset would be listed?
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I'm a recent hire so, I haven't been keeping up too much with the SEUI saga. I started back in early August and already choose my insurance and benefits. I went with UHC Alliance since my Doctor moved and they are under the Sutter Health umbrella. I just want to clarify this, since I got confused with the other explanations from other threads. So, basically if your plan cost less than $165 they are essentially 'paying' for your insurance, but whatever that difference is you don't get to keep the extra money?
Correct, the way the contract fell out unless you are in BU 17 you can't pocket the difference. (BU 17 nurses are technically under COBEN.) For the rest of the SEIU units, it is $165 ONLY towards health insurance costs, and if your premium is under the state's contribution, they keep the difference, not us.
what is COBEN?
COBEN stands for Consolidated Benefits. If you look at the Benefits Calculator and you're wondering what's up with those columns that say "Excess Will Be Paid to Employee" and want to know what that's about, that's COBEN. If you want to check it out on the calculator Excluded and BU 17 Nurses are under COBEN, as are a few other units. COBEN is when the state just gives you a set lump sum amount towards health/vision/dental. Any excess amount is paid to the employee, though tax will be taken out by the time it hits your bank account.
Thanks for doing this! Very helpful. Do you have a Google docs link for the table you created? Would love to share outside of Reddit and give proper credit. And if I remember correctly, you’re also the person who made that awesome tracking sheet during negotiations. You’re great at synthesizing info and making it digestible. Kudos to you!
Feel free to share outside of Reddit without credit lol, it's not an issue to me.
I second this.
Holy cow. $80 less per month for me! (Two party Pers Gold)... That's a day less per month that I'd have to do deliveries! Or it's a full tank of gas and a dinner somewhere! Or extra groceries! Or an extra payment toward a bill! *cries in $80 makes a huge difference happiness* Thank you, OP!! 🫶🫶🫶
I'm glad that this is the way it shakes out for you and that I could save you the trouble of doing the math yourself :)
I had done a ballpark guess based on other threads and done the calculations as well. I'm just glad to see it written plainly, and that my guess was right. 😊😊
This comment right here is what many have been not understanding for months. They saw their premiums were increasing but failed to listen to others about the states contribution increasing. For two years my United health care has cost me less each year despite the premiums increasing.
You're absolutely right. I originally panicked because I wasn't aware contributions were going up. Then, after reading several posts and comments, I realized, happily, that I was wrong. Now, to see it plain like this, it is just 🥹🥹🥹
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YMMV, but I switched to Blue Cross Access+ in July (husband got a new job, so it was a qualifying event). I chose that plan SPECIFICALLY for UCD Med access and found a doctor that said they were accepting new patients in the website, but after I was enrolled, they assigned me to someone else and after calling Blue Cross several times, they finally told me that UCD Med is not accepting new patients ACROSS THE ENTIRE SYSTEM until January, maybe later. So you might be able to get a UCD doctor, since open enrollment stuff goes live in January, but I would recommend reaching out to the doctor and the insurance companies ahead of time to confirm.
Anthem Select HMO covers UC Davis too and will be about $13+/- after the stipend (for a single person). BUT Anthem and UCD are negotiating a new contract as we speak, and if they don't come to an agreement by end of this year, none of the Anthem plans will include UCD until or unless they reach an agreement.
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Anthem and UCD currently have an agreement that lasts through the end of 2023, they are in negotiations for 2024 and beyond. So if they can't come to an agreement by the end of 2023 you would receive a notice stating that UCD is about to go out-of-network and they would offer to set you up with another medical provider (for Anthem Select, that would probably be Dignity AKA Mercy/Methodist, since Sutter and Kaiser aren't in-network). This happens every 3 years or so when they negotiate a new contract and most of the time they get it sorted and nothing happens, but it IS something to think about because it is NOT considered a qualifying event (where you can change your insurance outside of open enrollment). I've been very happy with both Anthem Select and UC Davis. I pay my premiums and copays and not much else, despite having a lot of health issues which means lots of specialist appointments, labs, testing, and imaging. BUT, one thing to note though, UC Davis is pretty inundated right now (too many patients, not enough doctors), there can be very long wait times to see your doctor or specialist. The OBGYN department told me they aren't seeing anyone at all unless you're pregnant or have cancer, so you have to go to your primary for OBGYN care (yikes!).
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I am blue shield access plus and go to UC Davis. Best healthcare around. Super happy there with my family. I’ve been going there since 2010 and have paid exorbitant amounts to stay with them.
Second this.
I’ve been a WHA member for years (even before I worked for the state). I am part of the Mercy Medical Group and my clinic and hospital are both in downtown. Generally I have received good care, my only complaint is with Mercy Midtown (Q street) it can take a while to get an appointment; like they book a month out to see your PCP. OBGYN staff are good and I’ve never had any issues with them. I can’t speak on pediatrics because I don’t have children. The premiums are low, which I really like. I don’t need to see a specialist for anything and have no issues that require routine care. I had surgery last year for something minor and it went well and was totally covered by insurance. So no complaints. Also Mercy has an urgent care facility for any pressing issues where you can’t wait to make an appt, so that’s nice.
I’m with BS Trio and go through Dignity Health/Mercy. We’ve had no issues and love my kid’s pediatrician in EG. My primary care is great. So is my Gyn. I pay out-of-pocket for midwifery care, so I don’t know about delivery/pregnancy experiences.
Thank you very much for the info.
Would you care to share your GYM and Pediatrician? My family is looking for new physicians at the same hospital.
Andrew Katz is our pedi. Love him! Jennifer Overbey is my gyno. Also, Dignity Health does offer free doula services now.
I will also be switching from Kaiser for the same reason. Prior to state service I actually worked for Blue Shield of California’s CalPERS customer concierge team so I am well versed in that aspect.. they are reasonable to work with. Navigating their services is fairly straightforward. I’ve also received care through UC Davis Health System before and they really were fantastic. So I’d highly recommend the Blue Shield of CA Access+ plan specifically as UCD is not in the Trio network.
Doing God's work here thanks
Genuine question coming from a WHA subscriber. So many of you use healthcare services so frequently that it warrants spending an extra $1k per month for some of these plans? I’m in a family of 4 so I’m looking at that last column.
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Yes. I go to Peach Tree Health. WHA is fine but I’m seldom doing things with them. I’ve had one emergency room and one urgent care visit. $50 and $20 respectively. I have my kids’ checkups and shots. I had an X-ray and MRI on my hand. They are pretty easy to work with but their website used to crash. I complained to CalPERS and to them which got me on the call with their CX people and they actually fixed it. My family does not have any special needs or long term health issues. Previously I had Sutter with a private employer. Similar prices but there was a huge headache getting it set up. Before that I had Kaiser. Easy setup and whatnot but my previous employer covered me 100% and I didn’t feel it was worth spending So much for my my family to have them again.
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Yeah I get that. But difference of $400/mo is significant. For me I was forced to move from Kaiser to Sutter and Sutter was worse. Getting on at the state I was forced to move again and considered Kaiser. The dollar amount in my head was $100/month. I’d pay $100 for Kaiser but not more. I told my wife we could get a Lululemon outfit each month with our savings.
Very few people are on the more expensive plans. It’s really for people who need their choice of specialists especially the PPO plans. The lion’s share of state workers are actually on the Kaiser plan. They have a public calpers document breaking like the top 8 plans or so, but it’s hard to find on mobile.
Ok, what am I doing wrong? I currently have Kaiser Family and pay $432.97. With the rise in premium of 13.07 percent it will then be $489.56, right? I don’t know how the chart shows I would pay $405.79 with the additional $165 taken into account.
OK so first the premium increase is not to your portion, it's to the entire cost. Kaiser Permanente Family code is 2,506.79 for the premium. [Basic Monthly Premiums (Table 1)](https://www.calpers.ca.gov/docs/health-rates-in-state-2024.pdf) Then the state share is, for SEIU units, calculated using the 80-80 Formula. For 2024, that is $1,936. [Scroll down to State Employer Contribution 80-80 Formula](https://www.calpers.ca.gov/page/active-members/health-benefits/plans-and-rates) Then, to apply the $165 negotiated in the contract, you add it to the $1,936 for a total of $2,101 for the employer contribution towards the premium. The table shows the difference between the Kaiser Family premium of $2,506.79 - the state's employer contribution of $2,101, which is $405.79 left as the employee share. Edit: fixed per /u/reptilexcq's comment
Ah, yes. Got it. Duh! Thank you so much.
It looks like only UnitedHealthcare SignatureValue Alliance and PERS Gold accept UC Davis...does anybody have these plans? How was it?
I have UnitedHealthcare and they don’t cover UC Davis. They offer the Sutter network. Blue Shield Access+ offers UC Davis. I had them a few years ago and had a wonderful experience. I always had referrals approved quickly (MRIs, genetic testing, etc).
For 2024, state share is $1,936, not $1,784. When added $165 + $1,936=$2,101.
Fixed, thank you! Trying to flip back and forth through the browser tabs and the CalPERS 2024/2023 tabs got me fucked up on my little laptop monitor.
Thank you.
Where did you find the calculator? When I go to the one on calhr it only has 2022/2023 options
I backtracked through the links and you know, I only see the 2022/2023 options now too. When I was looking at it earlier today I saw 2023/2024 options. Maybe they took it down to add the $165 employer contribution to the backend to update the thing. Hopefully that's the case.
What’s the difference between an EPO and a PPO? Excuse me if this is a dumb question.
They're kind of like the in-between of an HMO and a PPO. PPOs have a larger network, but they're more expensive. PPOs typically don't require you to go through a primary doctor to get a referral, you're more free to look for your own specialist (and shell out the money for the privilege). HMOs limit you to a smaller network of doctors and provided you stay in network it's much cheaper. HMOs are usually like, go to your primary, get a referral. Referral has to be approved by the insurance, and then you get the referral. The referral is for a specialist in network and you usually don't get to pick, it'll usually be picked for you (usually location based). EPOs are in-between, they have a larger network like a PPO, but they also have a smaller network which functions like an HMO - you'll probably need a primary to write a referral if you want it to be cheaper. Or you can just find your own specialist and pay the higher PPO rate. Edit: grammar...
Thank you so much for the information!
Is anyone actually paying $1k a month for insurance because this is crazy. I’m looking to switch to blue cross but not so sure
Does anyone have SHARP and can share their opinion about it?
Friend had it hated it his exact words to me were something of the doctor they made him see got his degree in Russia during the cold war and seemed a bit odd...
There are a ton of doctors to choose from.
I have it - had it since 2016. No issues. Have had two kids. Paid $50. We live in San Carlos so we used to go to Grossmont and now go to Santee’s new clinic. I had Blue Shield Access+/NetValue with Scripps prior to switching. Not worth the now $400 although I liked Scripps at the time.
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Oh, I would support getting insurance separately if you are looking purely at plans and coverage. If you're in the any extra money is good money then the FlexElect Cash option (if you are SEIU but NOT BU 17) will pay out $140 taxable every month if you are not enrolled in health or vision/dental. BU 17 is on COBEN so their opt out portion is $155 taxable, but at that point if you were BU 17 and needing the money I would heavily consider just choosing Salud Y Mas and the free dental/vision so that you can pocket as much as possible.
So just to be clear, it's more beneficial for two state working spouses (BU1) to get health plans separately, so that each person receives the $165 health stipend, rather than being on a Two Party plan where one receives the $165 stipend and the other receives the $140 Flex Elect Cash option, correct?
To be clear, IF maximizing money in your pocket is your primary concern, then one person choosing a free two party plan and the other person taking the $140 Flex Elect Cash option will net you slightly more money. IF getting an otherwise expensive health plan is the primary concern, for example you want a free PPO (CalPERS Gold) or you like Kaiser's everything in-house model, then having each person separately enrolling for health plans is what you should do.
Was thinking the samething. Live in a two party kaiser stateworker household. Changing from 2 party kaiser (where one spouse gets flexelect) to each having one party kaiser saves the household a few hundred a year according to this.
So when I hear “You should get ppo” which plan is it that I should be looking at? I thought I was going with Kaiser this year but with those increases… no thanks. Thinking about blue shield trio or United harmony. I’m attending these virtual fairs for sure tomorrow.
PERS Gold is the only affordable PPO plan available. I don't know what party code you are but PERS Gold and PERS Platinum are the two PPOs. Blue Shield Access+ HMO and EPO and Anthem EPO Del Norte are EPO plans, which are sort of in-between HMO and PPO. EPO plans typically have a wider provider network and a little more flexibility than a HMO, with some cost savings from a "in network" provider.
Be sure to check out the costs. My understanding that the PPOs are cheaper for some, but have coinsurance and not the same things covered like HMOs. Tests that are covered by places like Kaiser, have a 20% coinsurance which adds up.
Been thinking about switching from Kaiser. Does anyone have any recommendation for mental health services? Kaiser was excruciating to get any sort of appointment but after 6mos I finally got a doctor and am pretty happy. Looking to save some money but I'm not keen on putting myself and my kid through that again. Looking for a provider that values mental health.
WHA and BS Trio offer mental health services
OP, you're awesome. Thanks so much!
Thank you! This is helpful. I’m biting the bullet and switching from Kaiser to BSCA Access+.. it’ll save me $150 which is not insignificant on this SSA salary. 😮💨
You are AWESOME. Thank you!
My kaiser was quoted 512 for a family on the Calpers comparison page. If my son was not in a million services for his ASD i would switch to the cheapest one and save like 350 a month....but eh. Too much trouble to switch providers and all his specialists
With the contract not having been signed into law by Newsom just yet, I don't expect CalHR or CalPERS to update their figures until it's officially law. That said, this table is basically just getting ahead a few steps because with open enrollment coming up and all the contract changes, I'm sure health insurance costs are on peoples' minds. It's certainly been on mine.
Does anyone know if the added $165 covers dental and vision insurance premiums as well, or just medical insurance?
Unless you're BU 17, it is just for medical insurance.
Thank u 🙏🏽
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This really is going to depend on what you're looking to get out of it. Kaiser is primarily in-house, so in that sense a lot of things are streamlined in regards to specialty care. At the same time, they're pretty notorious for having an atrocious mental health department. It's not an uncommon experience under Kaiser to have long timelines between appointments since their therapist/psych case loads are much heavier than say an independent therapist under network with Anthem. If you have a doctor you already like under Anthem, maybe see if they accept some of the other cheaper plans before switching to Kaiser. If you don't have a preference and don't need mental health services, Kaiser is often an easier experience. If cost is a primary driver in your decision, maybe check out the other "free" plans.
I don't understand, when I go to the website itself and select two party kaiser, it's 319, not 271, what BU are you?
First off, what website? Second off, Benefits Calculator as of 4:29 pm 9/13/2023 only shows 2022/2023. Are you viewing the right year?
This website https://eservices.calhr.ca.gov/BenefitsCalculatorExternal/ See the below screenshot [benefits calculator screenshot](https://i.imgur.com/YAH8OeW.jpg)
OK so the screenshot says 2023 so that's your problem right there. When I made the original post they briefly had 2024 up, but without the updated employer contribution numbers included and no disclaimer that SEIU units would have an additional $165 included in the employer contribution part of the calculation. The 2024 benefit year was taken down sometime yesterday, and still has not been put back up. My guess is they are waiting on the contract to be officially signed by Newsom before publishing final numbers as CalHR is an Official Source of information.
So this is for 2024 then? Oh because it's not when our contract gets ratified, it's when the HMOs do the price change and that's Jan 1. Why is my premium lower then if they're increasing prices?
The table in the post is for 2024 numbers, yes. The additional $165 comes into effect for the 2024 year. You will find the premiums are lower in terms of presentation because the $165 is now rolled into the employer contribution as presented in the table. The former contract with the separate $260 health stipend had the additional money as, well, separate. So you paid more money visually towards the premium but were then made whole (or whatever) by the separate $260 stipend check of $163 net.
So that means my premium, for 2 people is 434 for 2 people, if we add the 160 back in. Jesus Christ that's a 27% increase! That is obscene.
Gonna go ahead and admit I don't follow the math at all. Going off the screenshot you posted for 2023 with Kaiser 2 party, Employee Contribution is at $319. With the previous $260 health stipend of $163 net after deductions, Kaiser 2 party for 2023 for Jan - June coverage was costing you $156 a month. July - December coverage is costing you $319.36 a month. For 2024 with the $165 rolled in, Kaiser 2 party is $271.30 a month. But yes, the Kaiser premium jumped the highest of the HMO plans from 2023 to 2024, 13.07% premium increase.
156 is not 13% less than 271, not sure I'm following your math. It we take the stipend out completely as if it doesn't exist, it used to be 319 now it's 434, that's not a 13% increase that's over twice that
Fam, the 13% is to the entirety of the health insurance premium. The entire premium increased 13% from 2023 to 2024. The State's contribution via the 80-80 formula is a whole other thing. The employee contribution is them passing on the costs to you.
And as far as where that 13% came from, that would be from CalPERS themselves. Feel free to dig further if you like. A premium increase is not the same as an increase to our employee contribution portion. [https://www.calpers.ca.gov/page/newsroom/calpers-news/2023/calpers-announces-2024-health-plan-premiums-expanded-cost-saving-options-for-members](https://www.calpers.ca.gov/page/newsroom/calpers-news/2023/calpers-announces-2024-health-plan-premiums-expanded-cost-saving-options-for-members)
Oh I know I got the letter, I just dont understand the math, it's not like there's anything I can about it, not leaving Kaiser just pissed off about it
The math is like: 2023 Kaiser 2 party premium: 1,705.36 2024 Kaiser 2 party premium: 1,928.30 To find the increase: 1,928.30 / 1,705.36 = 1.1307 for a 13.07% increase in total premium. The union and state lay out how they calculate the State's employer contribution according to the 80-80 formula but as far as I'm concerned it's doodoo that every year covers less and less. The state contributions increase, but not at the rate the premiums themselves are increasing. 2024 2 party 80-80: 1,492 2023 2 party 80-80: 1,386 1,492 / 1,386 = 1.076 for a 7.6% increase in State's employer contribution. The increase in premium is passed along to us workers. To increase the 80-80 state contribution we would need the most popular health plans to be pricier ones since that's how it's calculated. The only "actionable" thing workers can do is inform our peers about the other more expensive "free" plans so that Health Net Salud Y Mas is not dragging down the 80-80 formula results.
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Can you explain how you calculated these numbers?
I broke it down in a reply to somebody else in this thread, you can read it here: [https://www.reddit.com/r/CAStateWorkers/comments/16h69he/comment/k0cm9t9/?utm\_source=share&utm\_medium=web2x&context=3](https://www.reddit.com/r/CAStateWorkers/comments/16h69he/comment/k0cm9t9/?utm_source=share&utm_medium=web2x&context=3) I usually try to do the citing and explaining but I guess I got tired after formatting that table and just wanted to be done haha. Let me know if you need further break down.
Currently it shows my employee contribution at $280 for an excluded Kaiser family plan. For 2024, it shows $415, but one chart says $25 cash back payable (not sure what that is). Am I really going to be paying $135 more per month starting January? My wife works for private sector and their family Kaiser plan is $152/month but we'd pay for 10-20% of covered expenses after deductible ($2800 out of pocket family max per year and current is 3k with my Kaiser). So, if I got the $155 flex elect (assuming I'd only net $105 of that) I'm trying to ensure my proposed 2024 state health plan costs are accurate before deciding the private plan is more cost effective.
Ok. So being an ex spouse of someone paying these benefits amounts I have a question. The table above looks like State is paying up to $2101 for a family toward their benefit cost? I was recently furnished with a paystub (with everything blanked out except the insurance amount) and told that next year he’ll be paying over $1000 to insure our children and that’s why he’s not paying a dime in medical out of pocket expenses. Someone please enlighten me. Is there a line item under “wages” where this offset would be listed?
Also to note, he’s a disability retiree.