ABCDEFGHIJKLPQRSTUVWXYZ
1
2
2026-2027 Placer Union High School District - Medical, Dental & Vision Benefits
3
4
Calculated on FTE % - 1
5
6
Employees with 11 pay periods -Librarians and some ClericalEmployees with 10 pay periods -Instructional Aides, Campus Monitor and Food Service
7
Monthly District DistrictEstimatedDistrictEstimated
8
DISTRICT CAPCost Cap for ContributionMonthly Employee'sContributionMonthly Employee's
9
PLAN Tier of PlanFull Time% of FT CapDeduction% of FT CapDeduction
10
11
KaiserEmployee$1,283.00 $913.00 $996.00 $403.64 $1,095.60 $444.00
12
Traditional HMO W /OPTEmp/Spouse$2,566.00 $913.00 $996.00 $1,803.27 $1,095.60 $1,983.60
13
Emp/Child$1,951.00 $913.00 $996.00 $1,132.36 $1,095.60 $1,245.60
14
Family$3,015.00 $913.00 $996.00 $2,293.09 $1,095.60 $2,522.40
15
16
17
1000 Kaiser DHMO w/Opt. Employee$1,173.00$913.00 $996.00 $283.64 $1,095.60 $312.00
18
$1000 $10/$30/20% Rx Emp/Spouse$2,345.00$913.00 $996.00 $1,562.18 $1,095.60 $1,718.40
19
with health savings accountEmp/Child$1,782.00$913.00 $996.00 $948.00 $1,095.60 $1,042.80
20
Family$2,755.00$913.00 $996.00 $2,009.45 $1,095.60 $2,210.40
21
22
2000 Kaiser HDHP High Deductible Plan
Employee$922.00$913.00 $996.00 $9.82 $1,095.60 $10.80
23
($2,000/$3,4000/$4,000)Emp/Spouse$1,844.00$913.00 $996.00 $1,015.64 $1,095.60 $1,117.20
24
with health savings accountEmp/Child$1,402.00$913.00 $996.00 $533.45 $1,095.60 $586.80
25
Family$2,167.00$913.00 $996.00 $1,368.00 $1,095.60 $1,504.80
26
27
3000 Kaiser HDHP High Deductible Plan
Employee$709.00$709.00 $996.00 $0.00 $850.80 $0.00
28
$3000$/3400/$6000Emp/Spouse$1,580.00$913.00 $996.00 $727.64 $1,095.60 $800.40
29
with health savings accountEmp/Child$1,201.00$913.00 $996.00 $314.18 $1,095.60 $345.60
30
Family$1,857.00$913.00 $996.00 $1,029.82 $1,095.60 $1,132.80
31
32
Sutter Health Traditional HMOEmployee$1,265.00$913.00 $996.00 $384.00 $1,095.60 $422.40
33
$25 copay w/chiro Emp/Spouse$2,529.00$913.00 $996.00 $1,762.91 $1,095.60 $1,939.20
34
Emp/Child$1,921.00$913.00 $996.00 $1,099.64 $1,095.60 $1,209.60
35
Family$2,972.00$913.00 $996.00 $2,246.18 $1,095.60 $2,470.80
36
37
1000 Sutter Health DMHOEmployee$1,011.00$913.00 $996.00 $106.91 $1,095.60 $117.60
38
Emp/Spouse$2,022.00$913.00 $996.00 $1,209.82 $1,095.60 $1,330.80
39
Emp/Child$1,536.00$913.00 $996.00 $679.64 $1,095.60 $747.60
40
Family$2,376.00$913.00 $996.00 $1,596.00 $1,095.60 $1,755.60
41
42
1750 Sutter Health Employee$944.00$913.00 $996.00 $33.82 $1,095.60 $37.20
43
High Deductible HMO $1,750/$3,400/$3,500Emp/Spouse$1,887.00$913.00 $996.00 $1,062.55 $1,095.60 $1,168.80
44
with health savings accountEmp/Child$1,433.00$913.00 $996.00 $567.27 $1,095.60 $624.00
45
Family$2,216.00$913.00 $996.00 $1,421.45 $1,095.60 $1,563.60
46
47
2500 Sutter Health Employee$836.00$836.00 $912.00 $0.00 $1,003.20 $0.00
48
High Deductible HMO $2,500/$3,240/$5,000Emp/Spouse$1,671.00$913.00 $996.00 $826.91 $1,095.60 $909.60
49
with health savings accountEmp/Child$1,269.00$913.00 $996.00 $388.36 $1,095.60 $427.20
50
Family$1,962.00$913.00 $996.00 $1,144.36 $1,095.60 $1,258.80
51
52
53
Western Health Advantage HMOEmployee$1,010.00$913.00 $996.00 $105.82 $1,095.60 $116.40
54
$25 copay w/chiro Emp/Spouse$2,020.00$913.00 $996.00 $1,207.64 $1,095.60 $1,328.40
55
Emp/Child$1,536.00$913.00 $996.00 $679.64 $1,095.60 $747.60
56
Family$2,374.00$913.00 $996.00 $1,593.82 $1,095.60 $1,753.20
57
58
1000 Western DHMOEmployee$777.00$777.00 $847.64 $0.00 $932.40 $0.00
59
$1000/20/20/20% w.chiroEmp/Spouse$1,554.00$913.00 $996.00 $699.27 $1,095.60 $769.20
60
Emp/Child$1,181.00$913.00 $996.00 $292.36 $1,095.60 $321.60
61
Family$1,826.00$913.00 $996.00 $996.00 $1,095.60 $1,095.60
62
63
1800 Western Health Advantage Employee$738.00$738.00 $805.09 $0.00 $885.60 $0.00
64
High Deductible HMO $1,800/$3,400/$3,600Emp/Spouse$1,475.00$913.00 $996.00 $613.09 $1,095.60 $674.40
65
with health savings accountEmp/Child$1,121.00$913.00 $996.00 $226.91 $1,095.60 $249.60
66
Family$1,733.00$913.00 $996.00 $894.55 $1,095.60 $984.00
67
68
2800 Western Health AdvantageEmployee$640.00$640.00 $698.18 $0.00 $768.00 $0.00
69
High Deductible HMO $2,800/$3,400/$5,600Emp/Spouse$1,280.00$913.00 $996.00 $400.36 $1,095.60 $440.40
70
with health savings accountEmp/Child$973.00$913.00 $996.00 $65.45 $1,095.60 $72.00
71
Family$1,504.00$913.00 $996.00 $644.73 $1,095.60 $709.20
72
73
Blue Shield TrioEmployee$1,653.00 $913.00 $996.00 $807.27 $1,095.60 $888.00
74
HMOEmp/Spouse$3,305.00 $913.00 $996.00 $2,609.45 $1,095.60 $2,870.40
75
*Out-of-Area ResidentsEmp/Child$2,528.00 $913.00 $996.00 $1,761.82 $1,095.60 $1,938.00
76
Family$3,883.00 $913.00 $996.00 $3,240.00 $1,095.60 $3,564.00
77
78
2700 Blue Shield PPO Savings Employee$1,308.00 $913.00 $996.00 $430.91 $1,095.60 $474.00
79
High Deductible $2,700/$3,200/$5,200Emp/Spouse$2,620.00 $913.00 $996.00 $1,862.18 $1,095.60 $2,048.40
80
with health savings accountEmp/Child$2,004.00 $913.00 $996.00 $1,190.18 $1,095.60 $1,309.20
81
*Out-of-Area ResidentsFamily$3,079.00 $913.00 $996.00 $2,362.91 $1,095.60 $2,599.20
82
83
4400 Blue Shield PPO SavingsEmployee$1,182.00 $913.00 $996.00 $293.45 $1,095.60 $322.80
84
High Deductible $4,400/$4,400/$8,800Emp/Spouse$2,363.00 $913.00 $996.00 $1,581.82 $1,095.60 $1,740.00
85
with health savings accountEmp/Child$1,808.00 $913.00 $996.00 $976.36 $1,095.60 $1,074.00
86
*Out-of-Area ResidentsFamily$2,777.00 $913.00 $996.00 $2,033.45 $1,095.60 $2,236.80
87
88
Delta DentalComposite$113.50 $113.50 $123.82 $0.00 $136.20 $0.00
89
90
VSP VisionComposite$20.80 $20.80 $22.69 $0.00 $24.96 $0.00
91
92
*Out-of-Area Residents = Active employees living outside the Kaiser, Sutter Health Plus and Western Health Advantage service areas
93
Number of hours you work per day is based on your offer of employment (FTE)
94
*To calculate your percentage of full-time, divide the number of hours you work in a day by full time work day listed below
95
96
97
All Classified employees
8
98
99
100