About Retirees
The Board of Trustees established retiree medical benefits on the basis that Employer contributions for Active Participants will, if continued, partially maintain benefits for retirees. You will be required to pay a portion or all of the cost of coverage for retiree benefits. Retirees eligible for retiree coverage are required to pay a monthly premium to the Plan based on the Medicare status of the retiree and other eligible enrolled Dependents. The following rates are effective June 1, 2020:
| Definition | Members | Old Rate | New Rate |
| Early Retiree PPO | SINGLE | $480.00 | $505.00 |
| Early Retiree PPO w/Spouse under 65 | 2-PARTY | $841.00 | $891.00 |
| Early Retiree PPO w/Spouse over 65 | 2-PARTY | $771.00 | $821.00 |
| Early Retiree PPO Family | FAMILY | $1,033.00 | $1,108.00 |
| Early Retiree Kaiser | SINGLE | $350.00 | $375.00 |
| Early Retiree Kaiser w/Spouse under 65 | 2-PARTY | $642.00 | $692.00 |
| Early Retiree Kaiser w/Spouse over 65 | 2-PARTY | $538.00 | $588.00 |
| Early Retiree Kaiser Family | FAMILY | $884.00 | $959.00 |
| Early Retiree Disabled | SINGLE | $136.00 | $161.00 |
| Early Retiree Disabled w/Spouse under 65 | 2-PARTY | $338.00 | $388.00 |
| Early Retiree Disabled w/Spouse over 65 | 2-PARTY | $203.00 | $253.00 |
| Medicare 65 or older | SINGLE | $136.00 | $161.00 |
| Medicare 65 or older w/Spouse under 65 | 2-PARTY | $338.00 | $388.00 |
| Medicare 65-79 w/Spouse under 65 + Children | FAMILY | $670.00 | $745.00 |
| Medicare 65 or older w/Spouse over 65 | 2-PARTY | $203.00 | $253.00 |
| Medicare 65-79 w/Spouse 65-79 + Children | FAMILY | $445.00 | $520.00 |
Dental
The Plan provides dental care through an insured arrangement through Delta Dental with Group Number 2776-003. A separate booklet, which has been provided for you, is available at the Plan Office which describes this coverage.
Vision
Your vision benefits are provided through VSP. You will get the highest level of care, including a WellVision Exam – a comprehensive exam designed to detect eye and health conditions. When you see a VSP provider, you’ll get the most out of your benefit, have lower out-of-pocket costs, and your satisfaction is guaranteed.
Using your vision benefits:
- Register at vsp.com. Once your plan is effective, review your benefit information.
- Find an eyecare provider who is right for you. The decision is yours to make – choose a VSP provider or any out-of-network provider. To find a VSP provider, visit vsp.com or call (800) 877-7195.
- At your appointment, tell them you have VSP. There is no ID card necessary. If you would like a card as a reference, you can print one on vsp.com.
- There are no claim forms to complete when you see a VSP provider.
Hearing Care
Hearing care, which is provided by or ordered by a physician or certified audiologist, is subject to the following limits:
- $30 for one hearing examination in a 24-month period.
- The first $500 for each hearing device paid in full and 50% of any additional up to a maximum of $1,000 Plan payment. Limit of two hearing devices in a two-year period.
Medical Plans
1. Kaiser Permanente Senior Advantage (HMO) with Part D
2. Blue Shield of CA Medicare Supplement Plan
3. Kaiser Permanente HMO Plan for Early Retirees (non-Medicare)
4. Anthem Blue Cross PPO Plan for Early Retirees (non-Medicare)
5. Hartford Medicare Supplement Plan
2. Blue Shield of CA Medicare Supplement Plan
3. Kaiser Permanente HMO Plan for Early Retirees (non-Medicare)
4. Anthem Blue Cross PPO Plan for Early Retirees (non-Medicare)
5. Hartford Medicare Supplement Plan
Forms
- Anthem Blue Cross PPO Plan for Early Retirees - Enrollment Form
- Blue Shield of CA Medicare Supplement Plan - Enrollment Form
- Hartford Enrollment Form
- Kaiser Enrollment Form
- Kaiser Senior Advantage Enrollment Form
- SSA CMS Application Form L564
Documents
- Anthem Blue Cross PPO Plan for Early Retirees (non-Medicare) - Summary of Benefits
- Blue Shield of CA Medicare Supplement Plan - Summary of Benefits
- Calm Promotional - English
- Calm Promotional - Spanish
- Eligibility Rules for Retirees
- Hartford Summary of Coverage
- Kaiser Permanente HMO Plan for Early Retirees (non-Medicare) - Chiropractic Benefits
- Kaiser Permanente HMO Plan for Early Retirees (non-Medicare) - Summary of Benefits
- Kaiser Permanente Mindfulness and Self-Care Resources
- Kaiser Permanente Senior Advantage (HMO) with Part D - Chiropractic Benefits
- Kaiser Permanente Senior Advantage (HMO) with Part D - Summary of Benefits
- My Strength Flyer NCAL
- Retiree Medical Benefits Rates
- Self-Care - English
- Self-Care - Spanish
Useful Links