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Monthly Premium City Pays Employee Pays Medical Plan Coverage Level Employee + 1 $2,166.22 $1,220.88 $945.34 Employee + 2 or more $2,816.09 $1,587.14 $1,228.95 PERS Select – PPO** Employee only $487.20 $487.20 $0.00 Employee + 1 $974.40 $974.40 $0.00 Employee + 2 or more $1,266.72 $1,266.72 $0.00 PORAC - PPO Employee only $581.00 $581.00 $0.00 For members of the Police Employee + 1 $1,088.00 $1,088.00 $0.00 Officers’ Research Association Employee + 2 or more $1,382.00 $1,382.00 $0.00 MetLife Dental Coverage Level Monthly Premium City Pays Employee Pays Basic Plan Employee only $52.96 $52.96 $0 Employee + 1 $102.14 $102.14 $0 Employee + 2 or more $160.61 $160.61 $0 Buy-up Plan (Option 1) Employee only $27.38 $0.00 $27.38 Employee + 1 $55.23 $0.00 $55.23 Employee + 2 or more $101.63 $0.00 $101.63 Buy-up Plan (Option 2) Employee only $23.61 $0.00 $23.61 Employee + 1 $48.55 $0.00 $48.55 Employee + 2 or more $90.50 $0.00 $90.50 Sutter and Yuba counties ** Not available in Marin county Level City Employee Employee $52.10 $.86 2-party $100.48 $1.66 Family $158.00 $2.61 2011 Bay Area- Rates Benefit & Level City Employee Benefit & Level City Employee Blue Shield Access+1 $544.16 $131.35 PERSselect 1 $131.35 $28.87 Blue Shield Access+ 2 $1,088.32 $262.70 PERSselect 2 $262.70 $57.75 Blue Shield Access+ 3+ $1,386.82 $369.51 PERSselect 3+ $369.51 $103.07 Blue Shield Net Value 1 $513.25 $67.99 PERScare 1 $581.90 $312.05 Blue Shield Net Value 2 $1,026.49 $135.99 PERScare 2 $1,163.80 $624.10 Blue Shield Net Value 3+ $1,306.44 $204.78 PERScare 3+ $1,484.94 $839.33 Kaiser CA 1 $530.78 $38.21 PERSchoice 1 $ 504.26 $ 59.14 Kaiser CA 2 $1,061.55 $76.43 PERSchoice 2 $ 1,008.52 $ 118.28 Kaiser CA 3+ $1,352.02 $127.35 PERSchoice 3+ $ 1,283.07 $ 181.77 PORAC 1 $ 485.50 $ 41.50 PORAC 2 $ 906.50 $ 80.50 PORAC 3 $ 1,122.50 $ 131.50 2011 Other Northern CA Rates Benefit & Level City Employee Benefit & Level City Employee 24