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California State University, Long Beach
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Health Premium Rates 2008

Blue Shield trademarked logo Blue Shield NetValue

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only 0421 $430.25 $0.00 $0.00
Employee + 1 Dependent 0422 $860.50 $0.00 $0.00
Employee + 2 or more 0423 $1,118.65 $0.00 $0.00

Blue Shield trademarked logo Blue Shield HMO

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only 2051 $479.47 $8.47 $3.47
Employee + 1 Dependent 2052 $958.94 $72.94 $62.94
Employee + 2 or more 2053 $1,246.62 $117.62 $97.62

Kaiser Permanente trademarked logo Kaiser Permanente

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only 561 $436.25 $0.00 $0.00
Employee + 1 Dependent 562 $872.50 $0.00 $0.00
Employee + 2 or more 563 $1,134.25 $5.25 $0.00

CalPERS trademarked logo PERS-Care

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only 2781 $742.41 $271.41 $266.41
Employee + 1 Dependent 2782 $1,484.82 $598.82 $588.82
Employee + 2 or more 2783 $1,930.27 $801.27 $781.27

CalPERS trademarked logo PERS Choice

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only 2221 $477.70 $6.70 $1.70
Employee + 1 Dependent 2222 $955.40 $69.40 $59.40
Employee + 2 or more 2223 $1,242.02 $113.02 $93.02

CalPERS trademarked logo PERS Select

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only 0451 $462.55 $0.00 $0.00
Employee + 1 Dependent 0452 $925.10 $39.10 $29.10
Employee + 2 or more 0453 $1,076.00 $73.63 $53.63

PORAC †

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only 2071 $452.00 $0.00 N/A
Employee + 1 Dependent 2071 $847.00 $0.00 N/A
Employee + 2 or more 2071 $1,076.00 $0.00 N/A

Kaiser Permanente trademarked logo Kaiser (Out-Of-State)

Enrolled Employee & Eligible Dependents Code Total Mo. Premium Employee Mo. Ded. Unit 6 Mo. Ded.
Employee Only N/A $625.52 $154.52 $149.52
Employee + 1 Dependent N/A $1,251.04 $365.04 $355.04
Employee + 2 or more N/A $1,626.35 $497.35 $477.35

CSU CSU Contributions

Enrolled Employee & Eligible Dependents Gov't Code Unit 6
Employee Only $471.00 $476.00
Employee +1 Dependent $886.00 $896.00
Employee +2 or more $1,129.00 $1,149.00

†This plan is restricted to employees in Unit 8, State University Police Association (SUPA) and requires membership.