Antioch Unified School District

Antioch Unified School District offers various medical plan options through CalPERS. To determine which medical plan or provider is right for you depends on a variety of factors, such as whether you prefer a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO); your premium and out-of-pocket costs; and whether you want to have access to specific doctors and hospitals.

We realize that comparing medical plan benefits, features, and costs can be complicated. To help you make a decision, the CalPERS Health Benefit Summary booklet provides valuable information to help you make an informed choice about your medical plan and medical care providers. This publication compares covered services, co-payments, and benefits for each CalPERS health plan. It also provides information about plan availability by county and a chart summarizing important differences among health plan types. You can use this information to determine which health plan offers the services you need at the cost that works for you. The Health Benefit Summary provides only a general overview of certain benefits. It does not include details of all covered expenses or exclusions and limitations. Please refer to each health plan’s Evidence of Coverage (EOC) booklet for the exact terms and conditions of coverage. In case of a conflict between this summary and your health plan’s EOC, the EOC establishes the benefits that will be provided.

2024 Rates	EE Only	EE + One	EE + 2 more
Anthem Select HMO	$ 1,138.86	$ 2,277.72	$ 2, 961.04
Anthem Traditional HMO	$ 1,339.70	$ 2, 679.40	$ 3,483.22
United Health Care Alliance	$ 1,091.13	$ 2,182.26	$ 2,836.94
Kaiser CA HMO	$ 1,021.41	$ 2,042.82	$ 2,655.67
Blue Shield Access + HMO	$ 1, 076.84	$ 2, 153.68	$ 2,799.78
PERS Platinum PPO	$ 1,314.27	$ 2,628.54	$ 3,417.10
PERS Gold PPO	$ 914.82	$ 1,829.64	$ 2,378.53

2025 Rates	EE Only	EE + One	EE+ 2 or more
Anthem Select HMO	$1,256.65	$2,513.30	$3,267.29
Anthem Traditional HMO	$1,550.40	$3,000.80	$3,901.04
Blue Shield Access + HMO	$1,170.17	$2,340.34	$3,042.44
Blue Shield Trio HMO	$1,134.79	$2,269.58	$2,950.45
Kaiser HMO	$1,112.90	$2,225.80	$2,893.54
PERS Platinum PPO	$1,476.11	$2,952.20	$3,837.86
PERS Gold PPO	$1,013.70	$2,027.40	$2,635.62
United Healthcare Signature Value Alliance	$1,184.58	$2,369.16	$3,079.91
United Healthcare Signature Value Harmony	$1,005.02	$2,010.04	$2,613.05

2025 Health Benefit Summary- CalPERS

For rates outside of the Bay Area, please visit the CalPERS website: CalPERS Plans & Rates.

District Contribution/Cap

AUSD contributes towards the cost of your medical, dental and vision based on your medical plan election:

Single Medical Coverage: The district shall pay up to $13,354.80 per year/ $1,112.90 per month for all Certificated & Management employees and $12,256.92 per year/ $1021.41 per month for all Classified employees towards the cost of medical. This amount also includes the Districts minimum annualized monthly contribution required by CALPERS.

Two-Party Medical Coverage: The district shall pay up to $26,709.60 per year/ $2,225.80 per month for all Certificated & Management employees and $24,513.84 per year/ $2,042.82 per month for all Classified employees towards the cost of medical. This amount also includes the Districts minimum annualized monthly contribution required by CALPERS.

Family Medical Coverage: The district shall pay up to $34,722.48 per year/ $2,893.54 per month for all Certificated & Management employees and $31,868.04 per year/ $2655.67 per month for all Classified employees towards the cost of medical. This amount also includes the Districts minimum annualized monthly contribution required by CALPERS.

Part-time employees receive a prorated cap based on the number of hours you work, your FTE and bargaining unit.

AEA and Certificated Management- Your cap is based on your FTE. If you are full time, you will receive 100% of the Cap. If you work 80%, AUSD will contribute 80% of the premium cost up to the district cap (whichever is less) towards the cost of your plans. Example: If you select single medical Kaiser coverage, the total premium cost is $1,112.90. The district will pay 80% of the total premium or CAP whichever is less, so for this example we use the CAP since it is less. The single party CAP is $1112.90 x 80% = $890.32 and your monthly share would be $222.58.

CSEA , Classified Management and Confidential employees– If you are scheduled to work 35 hours or more per week the District will pay 100% of the Cap. If you work between 30 and 35 hours per week, the District will pay 85% of the premium cost or the Cap, whichever is less. If you work between 20 and 30 hours per week the District will pay 65% of the premium cost or the Cap, whichever is less. Example: If you select single medical Kaiser, the total premium cost is $ 1,112.90. The district will pay 85% of the total premium or the CAP, whichever is less. The single party CAP is $ 1,021.41 x 85% = $ 868.20 and your monthly share would be $244.70.

Cash In Lieu of Medical

Employees, who have alternative medical coverage through a group plan, may opt to waive their medical benefit. The current cash value of this option is $3,120 per year for Classified full-time employees, and $3,720 for Certificated & Management full-time employees, and is pro‐rated for part-time employees. (Employees must provide proof of medical insurance in the form of a letter from the employer providing alternative coverage or a copy of their medical ID card.) The amount received from Cash-In-Lieu is taxable income and does NOT count towards retirement credit under STRS/PERS.

Important facts if you waive coverage:

Employees who have previously elected to waive medical coverage and would like to enroll in a medical plan may do so only during the Open Enrollment period unless there has been a qualified change-in-status event.

Enrollment in Cash-In-Lieu may only occur at the time of hire or during the Open Enrollment period. There is no mid-year enrollment for Cash-In-Lieu unless you have a qualified change in status.

You must recertify each Open Enrollment Period for Cash-In-Lieu.

For a qualifying event enrollment, or a new Certificated Open enrollment, please use the HBD-12 form.

CalPERS HBD-12 Form

CalPERS (Medical Plan Administrators)

400 Q Street, Sacramento, CA 95811

(888) 225-7377

(800) 959-6545 fax

www.calpers.ca.gov

Anthem Blue Cross -
Anthem Traditional HMO, Anthem Select HMO

(855) 839-4524 (HMO)

(877) 737-7776 (PPO)
Anthem Blue Cross

Blue Shield of California-