Paul Extrum-Fernandez Brian Grimmer Andrea Winchester

Health Reimbursement Account (HRA) equals Subsidy amount Individual Plans Health Reimbursement Account (HRA) equals Subsidy amount Premiums, Copays, Dental, Vision Debit card OR Reimbursement Form Group Insurance Plans Billed Quarterly by Bop Subsidy included in the billed amount Regional Limitations Retiree Healthcare Options  

Individual Plan Options with Blue Shield of CA Medigap Plan Benefits Plan A Basic Medicare Supplement Plan C Coverage for Medicare Parts A & B deductibles, copays & coinsurance Plan D Coverage for Part A deductibles, copays & coinsurance Plan F Coverage for Medicare Parts A & B deductibles, copays & coinsurance. Includes 100% coverage for Part B excess charge High Deductible Plan F Same benefits as Plan F but with a lower monthly rate and $2,240 deductible Plan F Extra Same as Regular Plan F with lower deductibles also includes an emergency alert system, hearing aid benefits and some vision benefits Plan G Coverage for Medicare Part A deductibles, copays & coinsurance Includes 100% coverage for Part B excess charge Plan K Provides coverage for Medicare Part A coinsurance and a portion of Part B coinsurance, plus 50%of Medicare Part A deductible and more. Annual max copay for Plan K is $5,240 Plan N Same as Plan D but with $20 copay for office visits and $50 copay for ER visits Individual Plan Options with Blue Shield of CA

TOTAL ANNUAL SUBSIDY/HRA   TOTAL ANNUAL SUBSIDY/HRA CN Years of Service One Person Two Persons 20 or more $3,800 $7,600 19 $3,610 $7,220 18 $3,420 $6,840 17 $3,230 $6,460 16 $3,040 $6,080 15 $2,850 $5,700 14 $2,660 $5,320 13 $2,470 $4,940 12 $2,280 $4,560 11 $2,090 $4,180 10 $1,900 Retiree Subsidy or HRA Amount  

2019 Group Plan Benefit Summary KAISER UHC Deductible $0 Co-Pay Max $1,500 $6,700 Rx Plan Y Vision KP & MES Dental MetLife Discount 2019 Group Plan Benefit Summary

2019 Retiree Group Health Insurance Annual Premiums SUBSIDY RETIREE COST Kaiser HMO Within 30 miles of KP 1 Person $4,394 $3,800 $594 2 Persons $8,716 $7,600 $1,116 UnitedHealth Care (Certain CA Regions) $6,945 $3,145 $13,890 $6,290 Blue Shield PPO Outside of CA only $10,311 $6,511 $20,549 $12,949 2019 Retiree Group Health Insurance Annual Premiums

Paul Extrum-Fernandez Brian Grimmer Andrea Winchester