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LAPRA Retiree 2017-2018 Medical & Dental Premium Rates
Anthem Blue Cross PPO and CaliforniaCare HMO Premium Rates
The tables on pages 1 and 2 reflect the retiree monthly premium rates under the Anthem Blue Cross PPO
and CaliforniaCare HMO plans effective July 1, 2017. Your cost is the monthly premium rate minus the Pension
Department subsidy, based on your retirement date, age and years of service.
Anthem Blue Cross Monthly Premium Rates (07/01/17 - 06/30/18)
Office Use Only
Coverage Tier
PPO
HMO
(CA Residents Only)
10
Single - Retired No Medicare
$945.70
$894.03
11
2 Party - Retired No Medicare
$2,002.38
$1,662.23
12
Family - Retired No Medicare
$2,345.34
$1,945.90
20
Member B&D
$757.70
$795.03
20a
Member B Only
$798.70
$824.03
21
2 Party: Member B&D; Spouse A&B&D
$1,438.89
$1,440.74
21a
2 Party: Member B&D; Spouse A&B
$1,459.38
$1,456.25
21b
2 Party: Member B; Spouse A&B&D
$1,479.89
$1,469.74
21c
2 Party: Member B; Spouse A&B
$1,500.38
$1,485.25
22
2 Party: Member None; Spouse A&B&D
$1,626.89
$1,539.74
22a
2 Party: Member None; Spouse A&B
$1,647.38
$1,555.25
23
2 Party: Member B&D; Spouse B&D
$1,633.89
$1,510.28
23a
2 Party: Member B&D; Spouse B
$1,654.38
$1,525.79
23b
2 Party: Member B; Spouse B&D
$1,674.89
$1,539.28
23c
2 Party: Member B; Spouse B
$1,695.38
$1,554.79
24
2 Party: Member None; Spouse B&D
$1,821.89
$1,609.28
24a
2 Party: Member None; Spouse B
$1,842.38
$1,624.79
25
2 Party: Member B&D; Spouse None
$1,814.38
$1,563.23
25a
2 Party: Member B; Spouse None
$1,855.38
$1,592.23
26
3 Party: Member B&D; Spouse None; Deps None
$2,157.34
$1,846.90
26a
3 Party: Member B; Spouse None; Deps None
$2,198.34
$1,875.90
26b
3 Party: Member B&D; Spouse B&D; Deps None
$1,976.85
$1,793.95
27
3 Party: Member None; Spouse A&B&D; Deps None
$1,969.85
$1,823.41
27a
3 Party: Member None; Spouse A&B; Deps None
$1,990.34
$1,838.92
28
2 Party: Member B&D; Spouse A&D
$1,598.89
$1,478.18
29
3 Party: Member None; Spouse None; Deps A&B&D
$1,995.79
$1,840.85
29a
3 Party: Member None; Spouse None; Deps A&B
$2,013.34
$1,854.15
30
Member Only A&B&D
$576.70
$665.03
30a
Member Only A&B
$617.70
$694.03
31
2 Party: Member A&B&D; Spouse None
$1,633.38
$1,433.23
31a
2 Party: Member A&B; Spouse None
$1,674.38
$1,462.23
31b
2 Party: Member A&B&D; Spouse A&D
$1,417.89
$1,348.18
31c
2 Party: Member A&B&D; Spouse A
$1,438.38
$1,363.69
31d
2 Party: Member A&B; Spouse A&D
$1,458.89
$1,377.18
31e
2 Party: Member A&B; Spouse A
$1,479.38
$1,392.69
32
2 Party: Member A&B&D; Spouse B&D
$1,452.89
$1,380.28
32a
2 Party: Member A&B&D; Spouse B
$1,473.38
$1,395.79
32b
2 Party: Member A&B; Spouse B&D
$1,493.89
$1,409.28
32c
2 Party: Member A&B; Spouse B
$1,514.38
$1,424.79
33
2 Party: Both A&B&D
$1,257.89
$1,310.74
33a
2 Party: Member A&B; Spouse A&B&D
$1,298.89
$1,339.74
33b
2 Party: Member A&B&D; Spouse A&B
$1,278.38
$1,326.25
33c
2 Party: Both A&B
$1,319.38
$1,355.25
33d
2 Party: Member A&D; Spouse A&B&D
$1,404.89
$1,380.74
33e
2 Party: Member A Only; Spouse A&B&D
$1,445.89
$1,409.74
34
3 Party: Member A&B&D; Spouse None; Deps None
$1,976.34
$1,716.90