Retiree Contribution Rates
Jump to:
Employee Contribution Rates
View Employee Contribution Rates in the Medical Plans site
Grandfathered Retirees (Non-Medicare Eligible)
Download PDF File
2017 Monthly Contribution
| Medical Plan Costs Per Month |
Total Cost |
University Contribution |
Your Contribution |
|---|
| Kaiser Permanente HMO |
| Retiree Only |
$676.96 |
$676.96 |
$0.00 |
| Retiree & Spouse/Registered Domestic Partner |
$1,421.60 |
$1,165.72 |
$255.88 |
| Retiree & Child(ren) |
$1,218.52 |
$999.20 |
$219.32 |
| Retiree & Family |
$1,963.16 |
$1,609.80 |
$353.36 |
| Spouse/Registered Domestic Partner Only |
$744.64 |
$488.76 |
$255.88 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,286.20 |
$932.84 |
$353.36 |
| Child(ren) Only |
$541.56 |
$322.24 |
$219.32 |
| Stanford Health Care Alliance (SHCA) |
| Retiree Only |
$708.08 |
$676.96 |
$31.12 |
| Retiree & Spouse/Registered Domestic Partner |
$1,487.00 |
$1,165.72 |
$321.28 |
| Retiree & Child(ren) |
$1,274.60 |
$999.20 |
$275.40 |
| Retiree & Family |
$2,053.48 |
$1,609.80 |
$443.68 |
| Spouse/Registered Domestic Partner Only |
$778.92 |
$488.76 |
$290.16 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,345.40 |
$932.84 |
$412.56 |
| Child(ren) Only |
$566.52 |
$322.24 |
$244.28 |
| Aetna EPO |
| Retiree Only |
$933.40 |
$676.96 |
$256.44 |
| Retiree & Spouse/Registered Domestic Partner |
$1,960.08 |
$1,165.72 |
$794.36 |
| Retiree & Child(ren) |
$1,680.04 |
$999.20 |
$680.84 |
| Retiree & Family |
$2,706.76 |
$1,609.80 |
$1,096.96 |
| Spouse/Registered Domestic Partner Only |
$1,026.68 |
$488.76 |
$537.92 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,773.36 |
$932.84 |
$840.52 |
| Child(ren) Only |
$746.64 |
$322.24 |
$424.40 |
| Blue Shield Healthcare + Savings Plan |
| Retiree Only |
$793.84 |
$676.96 |
$116.88 |
| Retiree & Spouse/Registered Domestic Partner |
$1,585.88 |
$1,65.72 |
$420.16 |
| Retiree & Child(ren) |
$1,359.32 |
$999.20 |
$360.12 |
| Retiree & Family |
$2,190.00 |
$1,609.80 |
$580.20 |
| Spouse/Registered Domestic Partner Only |
$792.04 |
$488.76 |
$303.28 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,396.16 |
$932.84 |
$463.32 |
| Child(ren) Only |
$565.48 |
$322.24 |
$243.24 |
Grandfathered Retirees (Medicare Eligible)
Download PDF File
2017 Monthly Contribution
| Medicare Advantage Plans |
Total Cost |
University Contribution |
Your Contribution |
|---|
| Kaiser Permanente Senior Advantage |
| Retiree Only |
$302.56 |
$302.56 |
$0.00 |
| Retiree & Spouse/Registered Domestic Partner |
$605.26 |
$496.32 |
$108.94 |
| Retiree & Child(ren) |
$604.78 |
$495.92 |
$108.86 |
| Retiree & Family |
$905.88 |
$742.82 |
$163.06 |
| Spouse/Registered Domestic Partner Only |
$302.70 |
$193.76 |
$108.94 |
| Spouse/Registered Domestic Partner & Child(ren) |
$603.32 |
$440.26 |
$163.06 |
| Child(ren) Only |
$302.22 |
$193.36 |
$108.86 |
| Health Net Seniority Plus |
| Retiree Only |
$419.00 |
$302.56 |
$116.44 |
| Retiree & Spouse/Registered Domestic Partner |
$838.00 |
$496.32 |
$341.68 |
| Retiree & Child(ren) |
$838.00 |
$495.92 |
$342.08 |
| Retiree & Family |
$1,257.00 |
$742.82 |
$514.18 |
| Spouse/Registered Domestic Partner Only |
$419.00 |
$193.76 |
$225.24 |
| Spouse/Registered Domestic Partner & Child(ren) |
$838.00 |
$440.26 |
$397.74 |
| Child(ren) Only |
$419.00 |
$193.36 |
$225.64 |
| United Healthcare Group Medicare Advantage |
| Retiree Only |
$412.00 |
$302.56 |
$109.44 |
| Retiree & Spouse/Registered Domestic Partner |
$824.00 |
$496.32 |
$327.68 |
| Retiree & Child(ren) |
$824.00 |
$495.92 |
$328.08 |
| Retiree & Family |
$1,236.00 |
$742.82 |
$493.18 |
| Spouse/Registered Domestic Partner Only |
$412.00 |
$193.76 |
$218.24 |
| Spouse/Registered Domestic Partner & Child(ren) |
$824.00 |
$440.26 |
$383.74 |
| Child(ren) Only |
$412.00 |
$193.36 |
$221.10 |
| Medicare Supplement Plans |
Total Cost |
University Contribution |
Your Contribution |
|---|
| Blue Shield Retiree Medical Plan |
| Retiree Only |
$491.52 |
$302.56 |
$188.96 |
| Retiree & Spouse/Registered Domestic Partner |
$983.04 |
$496.32 |
$486.72 |
| Retiree & Child(ren) |
$983.04 |
$495.92 |
$487.12 |
| Retiree & Family |
$1,474.56 |
$742.82 |
$731.74 |
| Spouse/Registered Domestic Partner Only |
$491.52 |
$193.76 |
$297.76 |
| Spouse/Registered Domestic Partner & Child(ren) |
$983.04 |
$440.26 |
$542.78 |
| Child(ren) Only |
$491.52 |
$193.36 |
$298.16 |
| United Healthcare Senior Supplement |
| Retiree Only |
$568.00 |
$302.56 |
$265.44 |
| Retiree & Spouse/Registered Domestic Partner |
$1,136.00 |
$496.32 |
$639.68 |
| Retiree & Child(ren) |
$1,136.00 |
$495.92 |
$640.08 |
| Retiree & Family |
$1,704.00 |
$742.82 |
$961.18 |
| Spouse/Registered Domestic Partner Only |
$568.00 |
$193.76 |
$374.24 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,136.00 |
$440.26 |
$695.74 |
| Child(ren) Only |
$568.00 |
$193.36 |
$374.64 |
| Health Net Medicare COB |
| Retiree Only |
$642.20 |
$302.56 |
$339.64 |
| Retiree & Spouse/Registered Domestic Partner |
$1,284.40 |
$496.32 |
$788.08 |
| Retiree & Child(ren) |
$1,284.40 |
$495.92 |
$788.48 |
| Retiree & Family |
$1,926.60 |
$742.82 |
$1,183.78 |
| Spouse/Registered Domestic Partner Only |
$642.20 |
$193.76 |
$448.44 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,284.40 |
$440.26 |
$844.14 |
| Child(ren) Only |
$642.20 |
$193.36 |
$448.84 |
Non-Grandfathered Retirees (Non-Medicare Eligible)
Download PDF File
2017 Monthly Premiums
| Non-Medicare Eligible |
2017 Monthly Premium |
|---|
| Kaiser Permanente HMO |
| Retiree Only |
$676.96 |
| Retiree & Spouse/Registered Domestic Partner |
$1,421.60 |
| Retiree & Child(ren) |
$1,218.52 |
| Retiree & Family |
$1,963.16 |
| Spouse/Registered Domestic Partner Only |
$744.64 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,286.20 |
| Child(ren) Only |
$541.56 |
| Stanford Health Care Alliance |
| Retiree Only |
$708.08 |
| Retiree & Spouse/Registered Domestic Partner |
$1,487.00 |
| Retiree & Child(ren) |
$1,274.60 |
| Retiree & Family |
$2,053.48 |
| Spouse/Registered Domestic Partner Only |
$778.92 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,345.40 |
| Child(ren) Only |
$566.52 |
| Aetna EPO |
| Retiree Only |
$933.40 |
| Retiree & Spouse/Registered Domestic Partner |
$1,960.08 |
| Retiree & Child(ren) |
$1,680.04 |
| Retiree & Family |
$2,706.76 |
| Spouse/Registered Domestic Partner Only |
$1,026.68 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,773.36 |
| Child(ren) Only |
$746.64 |
| Blue Shield Healthcare + Savings Plan |
| Retiree Only |
$793.84 |
| Retiree & Spouse/Registered Domestic Partner |
$1,585.88 |
| Retiree & Child(ren) |
$1,359.32 |
| Retiree & Family |
$2,190.00 |
| Spouse/Registered Domestic Partner Only |
$792.04 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,396.16 |
| Child(ren) Only |
$565.48 |
Non-Grandfathered Retirees (Medicare Eligible)
Download PDF File
2017 Monthly Premiums
| Medicare Eligible |
2017 Monthly Premium |
|---|
Medicare Advantage Plans
|
| Kaiser Permanente Senior Advantage |
| Retiree Only |
$302.56 |
| Retiree & Spouse/Registered Domestic Partner |
$605.26 |
| Retiree & Child(ren) |
$604.78 |
| Retiree & Family |
$905.88 |
| Spouse/Registered Domestic Partner Only |
$302.70 |
| Spouse/Registered Domestic Partner & Child(ren) |
$603.32 |
| Child(ren) Only |
$302.22 |
| Health Net Seniority Plus |
| Retiree Only |
$419.00 |
| Retiree & Spouse/Registered Domestic Partner |
$838.00 |
| Retiree & Child(ren) |
$838.00 |
| Retiree & Family |
$1,257.00 |
| Spouse/Registered Domestic Partner Only |
$419.00 |
| Spouse/Registered Domestic Partner & Child(ren) |
$838.00 |
| Child(ren) Only |
$419.00 |
| United Healthcare Group Medicare Advantage |
| Retiree Only |
$412.00 |
| Retiree & Spouse/Registered Domestic Partner |
$824.00 |
| Retiree & Child(ren) |
$824.00 |
| Retiree & Family |
$1,236.00 |
| Spouse/Registered Domestic Partner Only |
$412.00 |
| Spouse/Registered Domestic Partner & Child(ren) |
$824.00 |
| Child(ren) Only |
$412.00 |
Medicare Supplement Plans
|
| Blue Shield Retiree Medical Plan |
| Retiree Only |
$491.52 |
| Retiree & Spouse/Registered Domestic Partner |
$983.04 |
| Retiree & Child(ren) |
$983.04 |
| Retiree & Family |
$1,474.56 |
| Spouse/Registered Domestic Partner Only |
$491.52 |
| Spouse/Registered Domestic Partner & Child(ren) |
$983.04 |
| Child(ren) Only |
$491.52 |
| United Healthcare Senior Supplement |
| Retiree Only |
$568.00 |
| Retiree & Spouse/Registered Domestic Partner |
$1,136.00 |
| Retiree & Child(ren) |
$1,136.00 |
| Retiree & Family |
$1,704.00 |
| Spouse/Registered Domestic Partner Only |
$568.00 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,1360.00 |
| Child(ren) Only |
$568.00 |
| Health Net Medicare COB |
| Retiree Only |
$642.20 |
| Retiree & Spouse/Registered Domestic Partner |
$1,284.40 |
| Retiree & Child(ren) |
$1,284.20 |
| Retiree & Family |
$1,926.60 |
| Spouse/Registered Domestic Partner Only |
$642.20 |
| Spouse/Registered Domestic Partner & Child(ren) |
$1,284.40 |
| Child(ren) Only |
$642.20 |
Non-Grandfathered Retirees Worksheet
Download PDF File
Calculate Your 2017 Monthly Costs
| Step 1 |
From the Contribution Chart, enter the monthly cost for the medical plan and coverage level you want for 2017. |
$ _____________ |
| Step 2 |
Enter the annual contribution credit allowed for the coverage level you want in 2017. |
$ _____________ |
| |
Retiree Only: |
$137.70 |
|
| |
Retiree & Spouse/Registered Domestic Partner: |
$221.38 |
|
| |
Retiree & Child(ren): |
$221.38 |
|
| |
Retiree & Family: |
$305.06 |
|
| 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 2017. |
$ _____________ |
| 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 2017. |
$ _____________ |
| Step 7 |
If you want dental coverage in 2017, enter your cost from the Retiree Dental Plan Contribution Chart. |
$ _____________ |
| Step 8 |
If you want vision coverage in 2017, 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 2017. |
$ _____________ |
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 2017. |
$676.96 |
| Step 2 |
Enter the annual contribution credit allowed for the coverage level you want in 2017. |
$137.70 |
| |
Retiree Only: |
$137.70 |
|
| |
Retiree & Spouse/Registered Domestic Partner: |
$221.38 |
|
| |
Retiree & Child(ren): |
$221.38 |
|
| |
Retiree & Family: |
$305.06 |
|
| 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 2017. |
$1,377.00 |
| Step 5 |
Divide this number by 12 to get your monthly credit amount. |
$114.75 |
| 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 2017. |
$562.21 |
| Step 7 |
If you want dental coverage in 2017, enter your cost from the Retiree Dental Contribution chart. |
$32.44 |
| Step 8 |
If you want vision coverage in 2017, 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 2017. |
$594.65 |
Retiree Dental Plan
Download PDF File
2017 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 |
$38.44 |
$6.00 |
$32.44 |
| Retiree & Spouse/Registered Domestic Partner |
$80.76 |
6.00 |
$74.76 |
| Retiree & Child(ren) |
$69.20 |
6.00 |
$63.20 |
| Retiree & Family |
$111.52 |
6.00 |
$105.52 |
Retiree Vision Plan
Download PDF File
2017 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 |
$11.70 |
$0.00 |
$11.70 |
| Retiree & Spouse/Registered Domestic Partner |
$18.72 |
$0.00 |
$18.72 |
| Retiree & Child(ren) |
$19.10 |
$0.00 |
$19.10 |
| Retiree & Family |
$30.80 |
$0.00 |
$30.80 |
