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Retiree Contribution Rates

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Grandfathered Retirees (Non-Medicare Eligible)

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2020 Monthly Contribution

Medical Plan Costs Per Month Total Cost University Contribution Your Contribution
Kaiser Permanente HMO
Retiree Only $761.22 $761.22 $0.00
Retiree & Spouse/Registered Domestic Partner $1,598.55 $1,310.81 $287.74
Retiree & Child(ren) $1,370.20 $1,123.56 $246.64
Retiree & Family $2,207.53 $1,810.17 $397.36
Spouse/Registered Domestic Partner Only $837.33 $549.59 $287.74
Spouse/Registered Domestic Partner & Child(ren) $1,446.31 $1,048.95 $397.36
Child(ren) Only $608.98 $362.34 $246.64
Stanford Health Care Alliance 
Retiree Only $1,131.30 $1,051.30 $80.00
Retiree & Spouse/Registered Domestic Partner $2,375.69 $1,864.59 $511.10
Retiree & Child(ren) $2,036.32 $1,592.40 $443.92
Retiree & Family $3,280.71 $2,616.79 $663.92
Spouse/Registered Domestic Partner Only $1,244.39 $813.29 $431.10
Spouse/Registered Domestic Partner & Child(ren) $2,149.41 $1,565.49 $583.92
Child(ren) Only $905.02 $541.10 $363.92
New! Trio
Retiree Only $1,048.60 $988.60 $60.00
Retiree & Spouse/Registered Domestic Partner $2,202.03 $1,737.39 $464.64
Retiree & Child(ren) $1,887.46 $1,483.90 $403.56
Retiree & Family $3,040.89 $2,437.33 $603.56
Spouse/Registered Domestic Partner Only $1,153.43 $748.79 $404.64
Spouse/Registered Domestic Partner & Child(ren) $1,992.29 $1,448.73 $543.56
Child(ren) Only $838.86 $495.30 $343.56
Healthcare + Savings Plan 
Retiree Only $991.74 $911.74 $80.00
Retiree & Spouse/Registered Domestic Partner $2,082.63 $1,510.79 $571.84
Retiree & Child(ren) $1,785.12 $1,295.68 $489.44
Retiree & Family $2,876.00 $2,087.16 $788.84
Spouse/Registered Domestic Partner Only $1,090.89 $599.05 $491.84
Spouse/Registered Domestic Partner & Child(ren) $1,884.26 $1,175.42 $708.84
Child(ren) Only $793.38 $383.94 $409.44

Grandfathered Retirees (Medicare Eligible)

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2020 Monthly Contribution

Medicare Advantage Plans Total Cost University Contribution Your Contribution
Kaiser Permanente Senior Advantage
Retiree Only $343.50 $343.50 $0.00
Retiree & Spouse/Registered Domestic Partner $687.00 $563.34 $123.66
Retiree & Child(ren) $687.00 $563.34 $123.66
Retiree & Family $1,030.50 $845.01 $185.49
Spouse/Registered Domestic Partner Only $343.50 $219.84 $123.66
Spouse/Registered Domestic Partner & Child(ren) $687.00 $501.51 $185.49
Child(ren) Only $343.50 $219.84 $123.66
Health Net Seniority Plus
Retiree Only $542.22 $343.50 $198.72
Retiree & Spouse/Registered Domestic Partner $1,084.44 $563.34 $521.10
Retiree & Child(ren) $1,084.44 $563.34 $521.10
Retiree & Family $1,626.66 $845.01 $781.65
Spouse/Registered Domestic Partner Only $542.22 $219.84 $322.38
Spouse/Registered Domestic Partner & Child(ren) $1,084.44 $501.51 $582.93
Child(ren) Only $542.22 $219.84 $322.38
Medicare Supplement Plans Total Cost University Contribution Your Contribution
Blue Shield Retiree PPO
Retiree Only $470.95 $343.50 $127.45
Retiree & Spouse/Registered Domestic Partner $941.90 $563.34 $378.56
Retiree & Child(ren) $941.90 $563.34 $378.56
Retiree & Family $1,412.85 $845.01 $567.84
Spouse/Registered Domestic Partner Only $470.95 $219.84 $251.11
Spouse/Registered Domestic Partner & Child(ren) $941.90 $501.51 $440.39
Child(ren) Only $470.95 $219.84 $251.11
Health Net Medicare COB
Retiree Only $840.00 $343.50 $496.50
Retiree & Spouse/Registered Domestic Partner $1,680.00 $563.34 $1,116.66
Retiree & Child(ren) $1,680.00 $563.34 $1,116.66
Retiree & Family $2,520.00 $845.01 $1,674.99
Spouse/Registered Domestic Partner Only $840.00 $219.84 $620.16
Spouse/Registered Domestic Partner & Child(ren) $1,680.00 $501.51 $1,178.49
Child(ren) Only $840.00 $219.84 $620.16

Non-Grandfathered Retirees (Non-Medicare Eligible)

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2020 Monthly Premiums

Non-Medicare Eligible 2020 Monthly Premium
Kaiser Permanente HMO
Retiree Only $761.22
Retiree & Spouse/Registered Domestic Partner $1,598.55
Retiree & Child(ren) $1,370.20
Retiree & Family $2,207.53
Spouse/Registered Domestic Partner Only $837.33
Spouse/Registered Domestic Partner & Child(ren) $1,446.31
Child(ren) Only $608.98
Stanford Health Care Alliance
Retiree Only $1,131.30
Retiree & Spouse/Registered Domestic Partner $2,375.69
Retiree & Child(ren) $2,036.32
Retiree & Family $3,280.71
Spouse/Registered Domestic Partner Only $1,244.39
Spouse/Registered Domestic Partner & Child(ren) $2,149.41
Child(ren) Only $905.02
New! Trio
Retiree Only $1,048.60
Retiree & Spouse/Registered Domestic Partner $2,202.03
Retiree & Child(ren) $1,887.46
Retiree & Family $3,040.89
Spouse/Registered Domestic Partner Only $1,153.43
Spouse/Registered Domestic Partner & Child(ren) $1,992.29
Child(ren) Only $838.86
Healthcare + Savings Plan
Retiree Only $991.74
Retiree & Spouse/Registered Domestic Partner $2,082.63
Retiree & Child(ren) $1,785.12
Retiree & Family $2,876.00
Spouse/Registered Domestic Partner Only $1,090.89
Spouse/Registered Domestic Partner & Child(ren) $1,884.26
Child(ren) Only $793.38

Non-Grandfathered Retirees (Medicare Eligible)

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2020 Monthly Premiums

Medicare Eligible 2020 Monthly Premium

Medicare Advantage Plans

Kaiser Permanente Senior Advantage
Retiree Only $343.50
Retiree & Spouse/Registered Domestic Partner $687.00
Retiree & Child(ren) $687.00
Retiree & Family $1,143.90
Spouse/Registered Domestic Partner Only $343.50
Spouse/Registered Domestic Partner & Child(ren) $687.00
Child(ren) Only $343.50
Health Net Seniority Plus
Retiree Only $542.22
Retiree & Spouse/Registered Domestic Partner $1,084.44
Retiree & Child(ren) $1,084.44
Retiree & Family $1,626.66
Spouse/Registered Domestic Partner Only $542.22
Spouse/Registered Domestic Partner & Child(ren) $1,084.44
Child(ren) Only $542.22

Medicare Supplement Plans

Blue Shield Retiree Medical Plan
Retiree Only $470.95
Retiree & Spouse/Registered Domestic Partner $941.90
Retiree & Child(ren) $941.90
Retiree & Family $1,412.85
Spouse/Registered Domestic Partner Only $470.95
Spouse/Registered Domestic Partner & Child(ren) $941.90
Child(ren) Only $470.95
Health Net Medicare COB
Retiree Only $840.00
Retiree & Spouse/Registered Domestic Partner $1,680.00
Retiree & Child(ren) $1,680.00
Retiree & Family $2,520.00
Spouse/Registered Domestic Partner Only $840.00
Spouse/Registered Domestic Partner & Child(ren) $1,680.00
Child(ren) Only $840.00

Non-Grandfathered Retirees Worksheet

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Calculate Your 2020 Monthly Costs

Step 1 From the Contribution Chart, enter the monthly cost for the medical plan and coverage level you want for 2020. $ _____________
Step 2 Enter the annual contribution credit allowed for the coverage level you want in 2020. $ _____________
   Retiree Only:  $152.36  
   Retiree & Spouse/Registered Domestic Partner: $244.96  
   Retiree & Child(ren): $244.96  
   Retiree & Family: $337.56  
   Spouse Only: $92.60  
   Spouse & Child(ren): $244.96  
   Child(ren): $92.60  
Step 3 Enter your years of benefits-eligible employment, provided by Stanford Benefits.    _____________
Step 4 Multiply the credit by the years of service to get your annual contribution credit. This is the annual credit you receive for retiree medical coverage in 2020. $ _____________
Step 5 Divide this number by 12 to get your monthly credit amount. $ _____________
Step 6 Subtract your monthly credit amount in Step 5 from the monthly premium shown in Step 1. This is your monthly cost for medical coverage in 2020. $ _____________
Step 7 If you want dental coverage in 2020, enter your cost from the Retiree Dental Plan Contribution Chart. $ _____________
Step 8 If you want vision coverage in 2020, enter your cost from the Retiree Vision Plan Contribution Chart. $ _____________
Step 9 Add Step 6, Step 7 and Step 8. This is your total monthly cost for retiree health care coverage in 2020. $ _____________

Example (Non-Medicare Eligible Kaiser Permanente – Retiree Only)

Step 1 From the Contribution Chart, enter the monthly cost for the medical plan and coverage level you want for 2020. $761.22
Step 2 Enter the annual contribution credit allowed for the coverage level you want in 2020. $152.36
   Retiree Only:  $152.36  
   Retiree & Spouse/Registered Domestic Partner: $244.96  
   Retiree & Child(ren): $244.96  
   Retiree & Family: $337.56  
   Spouse Only: $92.60  
   Spouse & Child(ren): $244.96  
   Child(ren): $92.60  
Step 3 Enter your years of benefits-eligible employment (provided by Stanford Benefits when you retired). 10
Step 4 Multiply the credit by the years of service to get your annual contribution credit. This is the annual credit you receive for retiree medical coverage in 2020. $1,523.60
Step 5 Divide this number by 12 to get your monthly credit amount. $126.97
Step 6 Subtract your monthly credit amount in Step 5 from the monthly premium shown in Step 1. This is your monthly cost for medical coverage in 2020. $634.25
Step 7 If you want dental coverage in 2020, enter your cost from the Retiree Dental Contribution chart. $27.63
Step 8 If you want vision coverage in 2020, enter your cost from the Retiree Vision Contribution chart. $0.00
Step 9 Add Step 6, Step 7 and Step 8. This is your total monthly cost for retiree health care coverage in 2020. $661.88

Retiree Dental Plan

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2020 Monthly Contribution

NOTE: If you want to enroll in a Retiree dental plan, you must first be enrolled in a Retiree medical plan.

Dental Costs Per Month Total Cost University Contribution Your Contribution
Delta Dental PPO
Retiree Only $33.63 $6.00 $27.63
Retiree & Spouse/Registered Domestic Partner $70.65 $6.00 $64.65
Retiree & Child(ren) $60.53 $6.00 $54.53
Retiree & Family $97.51 $6.00 $91.51

Retiree Vision Plan

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2020 Monthly Contribution

NOTE: If you want to enroll in a Retiree vision plan, you must first be enrolled in a Retiree medical plan.

Vision Costs Per Month Total Cost University Contribution Your Contribution
VSP Vision Care
Retiree Only $10.56 $0.00 $10.56
Retiree & Spouse/Registered Domestic Partner $16.89 $0.00 $16.89
Retiree & Child(ren) $17.24 $0.00 $17.24
Retiree & Family $27.80 $0.00 $27.80