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2015 Contribution Rates for Retirees

These are the monthly contribution rates for retiree medical and dental.


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Grandfathered Retirees (Non-Medicare Eligible)

2015 Monthly Contribution

Medical Plan Costs Per Month Total Cost University Contribution Your Contribution
Kaiser Permanente HMO
Retiree Only $573.48 $573.48 $0.00
Retiree & Spouse/Registered Domestic Partner 1,204.28 984.48 219.80
Retiree & Child(ren) 1,032.24 843.84 188.40
Retiree & Family 1,663.04 1,359.52 303.52
Spouse/Registered Domestic Partner Only 630.80 411.00 219.80
Spouse/Registered Domestic Partner & Child(ren) 1,089.56 786.04 303.52
Child(ren) Only 458.76 270.36 188.40
Stanford HealthCare Alliance
Retiree Only $573.48 $573.48 $0.00
Retiree & Spouse/Registered Domestic Partner 1,204.28 984.48 219.80
Retiree & Child(ren) 1,032.24 843.84 188.40
Retiree & Family 1,663.04 1,359.52 303.52
Spouse/Registered Domestic Partner Only 630.80 411.00 219.80
Spouse/Registered Domestic Partner & Child(ren) 1,089.56 786.04 303.52
Child(ren) Only 458.76 270.36 188.40
Blue Shield EPO
Retiree Only $801.24  $573.48 $227.76 
Retiree & Spouse/Registered Domestic Partner 1,682.52 987.52 695.00
Retiree & Child(ren) 1,442.16 846.44 595.72
Retiree & Family 2,323.48 1,363.68 959.80
Spouse/Registered Domestic Partner Only 881.28 414.04 467.24
Spouse/Registered Domestic Partner & Child(ren) 1,522.24 790.20 732.04
Child(ren) Only 640.92 272.96 367.96
Blue Shield PPO
Retiree Only $887.64 $573.48 $314.16
Retiree & Spouse/Registered Domestic Partner 1,864.12 987.52 876.60
Retiree & Child(ren) 1,597.80 846.44 751.36
Retiree & Family 2,574.28 1,363.68 1,210.60
Spouse/Registered Domestic Partner Only 976.48 414.04 562.44
Spouse/Registered Domestic Partner & Child(ren) 1,686.64 790.20 896.44
Child(ren) Only 710.16 272.96 437.20
Blue Shield High Deductible
Retiree Only $731.04 $573.48 $157.56
Retiree & Spouse/Registered Domestic Partner 1,535.20 987.52 547.68
Retiree & Child(ren) 1,315.88 846.44 469.44
Retiree & Family 2,120.00 1,363.68 756.32
Spouse/Registered Domestic Partner Only 804.16 414.04 390.12
Spouse/Registered Domestic Partner & Child(ren) 1,388.96 790.20 598.76
Child(ren) Only 584.84 272.96 311.88

Grandfathered Retirees (Medicare Eligible)

2015 Monthly Contribution

Medicare Advantage Plans Total Cost University Contribution Your Contribution
Health Net Seniority Plus
Retiree Only $358.90 $280.92 $77.98
Retiree & Spouse/Registered Domestic Partner 717.80 460.86 256.94
Retiree & Child(ren) 717.80 460.38 257.42
Retiree & Family 1,076.70 690.88 385.82
Spouse/Registered Domestic Partner Only 358.90 179.94 178.96
Spouse/Registered Domestic Partner & Child(ren) 717.80 409.96 307.84
Child(ren) Only 358.90 179.46 179.44
Kaiser Permanente Senior Advantage
Retiree Only $280.92 $280.92 $0.00
Retiree & Spouse/Registered Domestic Partner 562.02 460.86 101.16
Retiree & Child(ren) 561.44 460.38 101.06
Retiree & Family 842.54 690.88 151.66
Spouse/Registered Domestic Partner Only 281.10 179.94 101.16
Spouse/Registered Domestic Partner & Child(ren) 561.62 409.96 151.66
Child(ren) Only 280.52 179.46 101.06
United Healthcare Group Medicare Advantage
Retiree Only $400.00 $280.92 $119.08
Retiree & Spouse/Registered Domestic Partner 800.00 460.86 339.14
Retiree & Child(ren) 800.00 460.38 339.62
Retiree & Family 1,200.00 690.88 509.12
Spouse/Registered Domestic Partner Only 400.00 179.94 220.06
Spouse/Registered Domestic Partner & Child(ren) 800.00 409.96 390.04
Child(ren) Only 400.00 179.46 220.54
Medicare Supplement Plans Total Cost University Contribution Your Contribution
Blue Shield Retiree Medical Plan
Retiree Only $454.28 $280.92 $173.36
Retiree & Spouse/Registered Domestic Partner 908.56 460.86 447.70
Retiree & Child(ren) 908.56 460.38 448.18
Retiree & Family 1,362.84 690.88 671.96
Spouse/Registered Domestic Partner Only 454.28 179.94 274.34
Spouse/Registered Domestic Partner & Child(ren) 908.56 409.96 498.60
Child(ren) Only 454.28 179.46 274.82
Health Net Medicare COB
Retiree Only $578.84 $280.92 $297.92
Retiree & Spouse/Registered Domestic Partner 1,157.68 460.86  696.82
Retiree & Child(ren) 1,157.68 460.38 697.30
Retiree & Family 1,736.52 690.88 1,045.64
Spouse/Registered Domestic Partner Only 578.84 179.94 398.90
Spouse/Registered Domestic Partner & Child(ren) 1,157.68 409.96 747.72
Child(ren) Only 578.84 179.46 399.38
United Healthcare Senior Supplement
Retiree Only $554.00 $280.92 $273.08
Retiree & Spouse/Registered Domestic Partner 1,108.00 460.86 647.14
Retiree & Child(ren) 1,108.00 460.38 647.62
Retiree & Family 1,662.00 690.88 971.12
Spouse/Registered Domestic Partner Only 554.00 179.94 374.06
Spouse/Registered Domestic Partner & Child(ren) 1,108.00 409.96 698.04
Child(ren) Only 554.00 179.46 374.54

Non-Grandfathered Retirees

2015 Monthly Premiums

Non-Medicare Eligible 2015 Monthly Premium
Kaiser Permanente HMO
Retiree Only $573.48
Retiree & Spouse/Registered Domestic Partner $1,204.28
Retiree & Child(ren) $1,032.24
Retiree & Family $1,663.04
Spouse/Registered Domestic Partner Only $630.80
Spouse/Registered Domestic Partner & Child(ren) $1,089.56
Child(ren) Only $458.76
Stanford HealthCare Alliance
Retiree Only $573.48
Retiree & Spouse/Registered Domestic Partner $1,204.28
Retiree & Child(ren) $1,032.24
Retiree & Family $1,663.04
Spouse/Registered Domestic Partner Only $630.80
Spouse/Registered Domestic Partner & Child(ren) $1,089.56
Child(ren) Only $458.76
Blue Shield EPO
Retiree Only $801.24
Retiree & Spouse/Registered Domestic Partner $1,682.52
Retiree & Child(ren) $1,442.16
Retiree & Family $2,323.48
Spouse/Registered Domestic Partner Only $881.28
Spouse/Registered Domestic Partner & Child(ren) $1,522.24
Child(ren) Only $640.92
Blue Shield PPO
Retiree Only $887.64
Retiree & Spouse/Registered Domestic Partner $1,864.12
Retiree & Child(ren) $1,597.80
Retiree & Family $2,574.28
Spouse/Registered Domestic Partner Only $976.48
Spouse/Registered Domestic Partner & Child(ren) $1,686.64
Child(ren) Only $710.16
Blue Shield High Deductible
Retiree Only $731.04
Retiree & Spouse/Registered Domestic Partner $1,535.20
Retiree & Child(ren) $1,315.88
Retiree & Family $2,120.00
Spouse/Registered Domestic Partner Only $804.16
Spouse/Registered Domestic Partner & Child(ren) $1,388.96
Child(ren) Only $584.84
Medicare Eligible 2015 Monthly Premium

Medicare Advantage Plans

Health Net Seniority Plus
Retiree Only $358.90
Retiree & Spouse/Registered Domestic Partner $717.80
Retiree & Child(ren) $717.80
Retiree & Family $1,076.70
Spouse/Registered Domestic Partner Only $358.90
Spouse/Registered Domestic Partner & Child(ren) $717.80
Child(ren) Only $358.90
Kaiser Permanente Senior Advantage
Retiree Only $280.92
Retiree & Spouse/Registered Domestic Partner $562.02
Retiree & Child(ren) $561.44
Retiree & Family $842.54
Spouse/Registered Domestic Partner Only $281.10
Spouse/Registered Domestic Partner & Child(ren) $561.62
Child(ren) Only $280.52
United Healthcare Group Medicare Advantage
Retiree Only $400.00
Retiree & Spouse/Registered Domestic Partner $800.00
Retiree & Child(ren) $800.00
Retiree & Family $1,200.00
Spouse/Registered Domestic Partner Only $400.00
Spouse/Registered Domestic Partner & Child(ren) $800.00
Child(ren) Only $400.00

Medicare Supplement Plans

Blue Shield Retiree Medical Plan
Retiree Only $454.28
Retiree & Spouse/Registered Domestic Partner $908.56
Retiree & Child(ren) $908.56
Retiree & Family $1,362.84
Spouse/Registered Domestic Partner Only $454.28
Spouse/Registered Domestic Partner & Child(ren) $908.56
Child(ren) Only $454.28
Health Net Medicare COB
Retiree Only $578.84
Retiree & Spouse/Registered Domestic Partner $1,157.68
Retiree & Child(ren) $1,157.68
Retiree & Family $1,736.52
Spouse/Registered Domestic Partner Only $578.84
Spouse/Registered Domestic Partner & Child(ren) $1,157.68
Child(ren) Only $578.84
United Healthcare Senior Supplement
Retiree Only $554.00
Retiree & Spouse/Registered Domestic Partner $1,108.00
Retiree & Child(ren) $1,108.00
Retiree & Family $1,662.00
Spouse/Registered Domestic Partner Only $554.00
Spouse/Registered Domestic Partner & Child(ren) $1,108.00
Child(ren) Only $554.00

Non-Grandfathered Retirees

Calculate Your 2015 Monthly Costs

Step 1 From the Contribution Chart, enter the monthly cost for the medical plan and coverage level you want for 2015. $ _____________
Step 2 Enter the annual contribution credit allowed for the coverage level you want in 2015. $ _____________
  Retiree Only: $128.54  
  Retiree & Spouse/Registered Domestic Partner: $206.64  
  Retiree & Child(ren): $206.64  
  Retiree & Family: $284.74  
Step 3 Enter your years of employment (provided by Stanford Benefits when you retired).    _____________
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 2015. $ _____________
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 2015. $ _____________
Step 7 IIf you want dental coverage in 2015, enter your cost from the Retiree Dental Plan Contribution Chart. $ _____________
Step 8 Add Step 6 and Step 7. This is your total cost for retiree health care coverage in 2015. $ _____________

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 2014 $573.48
Step 2 Enter the annual contribution credit allowed for the coverage level you want in 2014 $128.54
   Retiree Only:  $128.54  
   Retiree & Spouse/Registered Domestic Partner: $206.64  
   Retiree & Child(ren): $206.64  
   Retiree & Family: $284.74  
Step 3 Enter your years of 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 2015. $1285.40
Step 5 vide this number by 12 to get your monthly credit amount $107.12
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 2015. $466.36
Step 7 If you want dental coverage in 2014, enter your cost from the Retiree Dental Contribution chart. $31.96
Step 8 Add Step 6 and Step 7. This is your total cost for retiree health care coverage in 2015. $498.32

Retiree Dental Plan

2015 Monthly Contribution

Dental Costs Per Month Total Cost University Contribution Your Contribution
Delta Dental PPO
Retiree Only $37.96 $6.00 $31.96
Retiree & Spouse/Registered Domestic Partner $79.72 6.00 $73.72
Retiree & Child(ren) $68.32 6.00 $62.32
Retiree & Family $110.08 6.00 $104.08