Fresno County Health Cost Watch — The Raw Numbers (Plan Year 2027)

The Raw Numbers

Everything below comes from published County and SJVIA materials and the documents presented at the October 26, 2026 bargaining session. Where a figure is a proposal, it is stamped — the County’s 2027 contribution is still subject to meet-and-confer and approval, and final deduction tables have not been published.

What the County contributes toward your premium (biweekly, full-time)

OCTOBER 26, 2026 PROPOSAL — PENDING APPROVAL — NOT FINAL

County contribution per pay period, by coverage tier
Coverage tier	2026	Prior offer (pre-session)	Oct 26, 2026 proposal	Change vs 2026
Employee Only	$473	$473	$460	-$13
Employee + Spouse / Domestic Partner	$778	$803	$1,007	+$229
Employee + Child(ren)	$778	$843	$871	+$93
Family	$963	$1,198	$1,415	+$452

Sources: Fresno County employee health plan reference (2026 rate sheets); County of Fresno 2027 offer as reported in County open-enrollment materials (prior offer); and the County’s revised proposed contribution presented October 26, 2026 — MOU addendum (SEIU Local 521 Units 3, 4, 12, 22 & 36) and session rate sheet (“Rates approved by BOS on October 6, 2026 — County contribution pending approval”), effective pay period beginning December 21, 2026. The October 26 figures are a proposal, not a final, agreed rate.

What comes out of your paycheck in 2027 (biweekly employee deduction)

OCTOBER 26, 2026 PROPOSAL — PENDING APPROVAL — NOT FINAL

October 26, 2026 proposal — Plan Year 2027 biweekly employee deductions, including Delta Dental DPPO
Plan	Employee Only	Emp. + Spouse	Emp. + Child(ren)	Family
Anthem EPO Cypress	$60.34	$177.75	$99.64	$291.66
Anthem EPO Maple	$21.42	$88.23	$27.63	$163.21
Anthem HDPPO 3500	$0.00	$0.00	$0.00	$0.00
Kaiser HMO	$100.77	$263.42	$168.76	$411.50
Kaiser HDHP	$0.00	$0.00	$0.00	$0.00

October 26, 2026 proposal — Plan Year 2027 biweekly employee deductions, including DeltaCare DHMO
Plan	Employee Only	Emp. + Spouse	Emp. + Child(ren)	Family
Anthem EPO Cypress	$56.48	$161.73	$77.51	$257.01
Anthem EPO Maple	$17.56	$72.21	$5.50	$128.56
Anthem HDPPO 3500	$0.00	$0.00	$0.00	$0.00
Kaiser HMO	$96.91	$247.40	$146.63	$376.85
Kaiser HDHP	$0.00	$0.00	$0.00	$0.00

Sources: Rate sheet presented at the October 26, 2026 bargaining session (“Rates approved by BOS on October 6, 2026 — County contribution pending approval”), effective pay period beginning December 21, 2026. Proposal — pending approval, not final. Final deductions depend on the County contribution approved for 2027.

Why costs are going up: the SJVIA renewal

SJVIA final Plan Year 2027 renewal, by plan
Plan / coverage	2027 renewal change
Anthem self-funded plans	+21.24%
Kaiser HMO	+4.22%
Kaiser HDHP	+9.71%
Delta Dental DPPO	+4.04%

Source: SJVIA Plan Year 2027 final renewal.

What else changes in 2027

Three plans are eliminated. The Anthem EPO Yosemite, Sierra, and Pismo plans end after 2026. They are replaced by two new EPOs: Cypress and Maple.
High deductibles go up. The 2027 high-deductible plans (Anthem HDPPO and Kaiser HDHP) carry a $3,500 individual / $6,000 family deductible. The 2026 Anthem HDPPO deductible was $3,300 individual.
The employee-only contribution is cut. Under the County’s October 26 proposal, the Employee Only contribution drops from $473 to $460 — the only tier cut — while the dependent tiers rise above the County’s earlier offer (Family to $1,415).
Both high-deductible plans are $0 premium. Under the October 26 proposal, the Anthem HDPPO and Kaiser HDHP show a $0.00 employee deduction at every coverage tier. The cost on those plans sits in the deductible — $3,500 individual / $6,000 family — not in the premium.

Sources: SJVIA Plan Year 2027 final renewal; County of Fresno open-enrollment materials; Fresno County employee health plan reference (2026).

Family coverage vs. a county paycheck

Under the ACA, family coverage is considered unaffordable when the employee’s share of the lowest-cost family plan exceeds 10.22% of household income (the IRS percentage for plan year 2027). Measured against county pay ranges — using salary as the household-income measure for a single-earner family — the October 26, 2026 proposal numbers show:

On the cheapest family plans (Anthem HDPPO and Kaiser HDHP, $0.00 per pay period under the October 26 proposal), the premium alone exceeds the 10.22% threshold for no classification — on those plans the cost is the $3,500 / $6,000 deductible, not the premium.
On the median-cost family plan (Anthem EPO Maple, $163.21 per pay period = $4,243 a year), 3 of 132 SEIU-represented classifications exceed the 10.22% threshold at the midpoint of their pay range.
On the most expensive family plan (Kaiser HMO, $411.50 per pay period = $10,699 a year), 125 of 132 classifications exceed the threshold at midpoint pay.
The median-cost family plan stays under 10.22% only at a salary of $41,522 or more. At the entry step of the lowest-paid classifications, it takes 11.8% of gross pay.

Sources: Fresno County Salary Resolution, Section 100 (updated August 3, 2026); family-tier deductions under the County’s October 26, 2026 proposal (session rate sheet, pending approval); IRS Rev. Proc. 2026-26 (2027 affordability percentage: 10.22%). Analysis covers the 132 classifications in Units 3, 4, 12, 22, and 36.

What It Costs You

Pick your classification, where you sit in its pay range, your coverage tier, and a plan. The math runs entirely in your browser — nothing you select is sent or stored anywhere.

Uses October 26, 2026 PROPOSED 2027 deductions — PENDING APPROVAL — NOT FINAL

Annual salary used—

Biweekly deduction from your paycheck—

Your annual premium cost—

Premium as a share of your gross pay—

Estimated monthly take-home pay (before premium)—

Estimated monthly take-home left after premium—

Take-home is estimated at 72% of gross pay (after taxes and standard deductions) — an estimate for comparison, not a payroll figure. Annual premium = biweekly deduction × 26 pay periods. Deductions shown include Delta Dental DPPO. The 10.22% figure is the ACA affordability threshold for plan year 2027 (IRS Rev. Proc. 2026-26), applied to family coverage; for that comparison, the calculator uses your salary as the household-income figure.

In Their Words

The numbers have names. Fresno County employees, in their own words, on what the preliminary 2027 rates mean at their kitchen tables. Shared with permission. These accounts were shared under the County’s preliminary rates, before the revised proposal presented October 26, 2026.

$50.70 → $170.51 biweekly, employee + children

My name is Monica, and I am currently at the top of the pay scale for an Office Assistant II position. I currently pay $50.70 biweekly for health insurance coverage for myself and my three children, with $15 copays. Under the new rates, my biweekly premium would increase to $170.51, with $25 copays. This is a significant increase in both premiums and out-of-pocket costs. I work two jobs to meet my family’s financial obligations, including rent, utilities, car payments, car insurance, groceries, gas, and phone expenses. I also help support my daughter, who is away at college. With these responsibilities, the increased health insurance premium would place a substantial financial burden on my household.

The new premium would cost approximately $341.02 per month, compared to my current cost of approximately $101.40 per month. This increase is simply not affordable within my current budget. Additionally, I do not qualify for medical assistance because my gross income exceeds the eligibility limit, even though my take-home pay does not accurately reflect my financial obligations and available income.

I value my job, take pride in my work, and am committed to continuing to serve in my role. However, I am concerned that the substantial increase in health insurance costs will make it increasingly difficult for employees like me to afford adequate coverage for our families.

I respectfully ask that you reconsider these health insurance rate increases and explore more affordable plan options for employees and their dependents. Employees should not have to choose between maintaining essential health coverage and meeting their family’s basic living expenses. Thank you for your time and consideration. I sincerely hope you will take these concerns into account and work toward providing more affordable health care options for employees and their families.

— Monica, Office Assistant II, covering herself and three children

$192.64 biweekly — $385.28 a month on the Cypress plan

My name is Lakeisha I am a current employee for the County of Fresno. I am an Office Assistant II. I am a single parent of four children. I am a one household income and currently have Anthem BC along with the dental, and vision plan for me and my four children. I have attached a snip of what I have to pay for health coverage for me and four children which will end on 12/20/2026.

Now looking at the new rates for me and my four children I would have to get the Anthem EPO Cypress plan which will cost me $192.64 biweekly, I cannot afford to pay $385.28 a month for health coverage for me and my children. I am barely surviving now. I must pay rent, PG&E, water, garbage, car note, car insurance, health insurance, food, gas, and necessities for us.

With the rates going up I am forced to choose which bills I must pay. I have no help from family; I don’t get child support for my children. I take care of them alone along with all the bills that I must pay every month. With rates climbing the charts this is going to be a very big struggle for me I don’t know how me and my children are going to live, let alone eat.

— Lakeisha, Office Assistant II, single parent of four

“I would just be working to pay my insurance.”

To whom it may concern, my name is Elisa and I am an office assistant for Fresno County. I want to let you know that these price increases are not humane. How am I going to survive with this type of increase? I have so many medical appointments — I would just be working to pay my insurance. How would I pay for groceries and my monthly rent payment? We’re not getting any pay increase to help pay these high insurance premiums.

— Elisa, Office Assistant

What Care Costs

Premiums decide what comes out of your paycheck; the benefit design decides what care costs when you actually use it. Below is the cost-of-service detail for all five Plan Year 2027 plans — deductibles, copays and coinsurance, therapy and chiropractic limits, and prescription tiers — transcribed from the County’s published 2027 plan documents. Pick your plan and scan down.

Read this section carefully: the benefit designs shown are from the County’s published Plan Year 2027 plan documents. The County’s 2027 contribution toward premiums is still being bargained (subject to meet-and-confer), so no premium or deduction figure shown anywhere on this page is final. Each plan summary is a brief outline of coverage — if a summary and the Evidence of Coverage differ, the Evidence of Coverage prevails. The Kaiser documents are Kaiser’s “Disclosure Form Part One” principal-benefit summaries.

Anthem EPO Cypress — Anthem’s “Custom EPO 500”

In-network only, except emergency care, authorized services, or when required by law.

Anthem EPO Cypress — member cost of service, Plan Year 2027
Service	What you pay
Annual deductible (individual / family)	$500 / $1,000
Medical out-of-pocket maximum (individual / family)	$3,750 / $7,500
Pharmacy out-of-pocket maximum (individual / family)	$1,000 / $2,000 — a separate pharmacy out-of-pocket limit, in addition to the medical limit
Primary care	$25 copay; deductible does not apply
Specialist	$50 copay after deductible is met
Preventive care	No charge; deductible does not apply
Telehealth / virtual visits	Virtual-care-only providers (app/website): primary care $25, mental health & substance use $25 (deductible does not apply); specialist $50 after deductible
Urgent care	$50 copay; deductible does not apply
Emergency room — facility	$250 copay after deductible (same copay in- and out-of-network; copay waived if admitted)
Emergency room — physician	$50 copay after deductible (in- and out-of-network)
Ambulance	$100 copay per trip after deductible (in- and out-of-network)
Outpatient surgery — facility	$250 copay after deductible (hospital or ambulatory surgical center)
Outpatient surgery — physician / surgeon	$50 copay after deductible
Inpatient hospital — facility	$500 copay per admission after deductible
Inpatient hospital — physician	$50 copay per visit after deductible
Advanced imaging (MRI / CT / PET)	$100 copay after deductible (office, freestanding radiology center, or outpatient hospital)
Laboratory tests	$50 copay after deductible (office, freestanding lab, or outpatient hospital)
X-ray / diagnostic imaging	$50 copay after deductible (office, freestanding radiology center, or outpatient hospital)
Physical / occupational / speech therapy (cost and limit)	$25 copay; deductible does not apply (office and outpatient hospital). Limit: 60 days combined per benefit period
Chiropractic (cost and limit)	Manipulation therapy: $25 copay; deductible does not apply. Limit: 40 visits per benefit period
Acupuncture	$25 copay; deductible does not apply (no visit limit stated)
Mental health / substance use — outpatient, office visits	$25 copay (virtual and office); deductible does not apply
Mental health / substance use — outpatient, facility	Facility fees $100 copay after deductible; doctor services $50 copay after deductible
Mental health / substance use — inpatient	Covered under the Hospital benefit, which includes mental health and substance use services: facility $500 copay per admission after deductible; physician $50 copay after deductible
Prescription Tier 1 (retail, 30-day)	$10 copay per prescription
Prescription Tier 2 (retail, 30-day)	$20 copay per prescription
Prescription Tier 3 (retail, 30-day)	$50 copay per prescription
Prescription Tier 4 (retail, 30-day)	$150 copay per prescription (retail and home delivery)
Prescription mail order	Home delivery, 90-day supply: Tier 1 $15, Tier 2 $30, Tier 3 $75, Tier 4 $150. (A 90-day supply at a Retail 90 pharmacy costs 2× the 30-day retail copay.)
Prescription deductible	Not applicable — no pharmacy deductible (out-of-network pharmacy: not covered)
Home health (cost and limit)	$25 copay per visit; deductible does not apply. Limit: 100 visits per benefit period
Skilled nursing (cost and limit)	$25 copay per admission; deductible does not apply. Limit: 100 days per benefit period
Durable medical equipment (DME)	$25 copay; deductible does not apply

Source: official plan summary PDF posted by the County — Anthem Blue Cross “Your summary of benefits”: Custom EPO 500 (plan code dated 01-01-2027).

Anthem EPO Maple — Anthem’s “Custom EPO 1000”

In-network only, except emergency care, authorized services, or when required by law — with roughly double Cypress’s copays across the grid.

Anthem EPO Maple — member cost of service, Plan Year 2027
Service	What you pay
Annual deductible (individual / family)	$1,000 / $2,000
Medical out-of-pocket maximum (individual / family)	$7,500 / $15,000
Pharmacy out-of-pocket maximum (individual / family)	$2,000 / $4,000 — a separate pharmacy out-of-pocket limit, in addition to the medical limit
Primary care	$50 copay; deductible does not apply
Specialist	$100 copay after deductible is met
Preventive care	No charge; deductible does not apply
Telehealth / virtual visits	Virtual-care-only providers (app/website): primary care $50, mental health & substance use $50 (deductible does not apply); specialist $100 after deductible
Urgent care	$100 copay; deductible does not apply
Emergency room — facility	$500 copay after deductible (same copay in- and out-of-network; copay waived if admitted)
Emergency room — physician	$100 copay after deductible (in- and out-of-network)
Ambulance	$200 copay per trip after deductible (in- and out-of-network)
Outpatient surgery — facility	$500 copay after deductible (hospital or ambulatory surgical center)
Outpatient surgery — physician / surgeon	$100 copay after deductible
Inpatient hospital — facility	$1,000 copay per admission after deductible
Inpatient hospital — physician	$100 copay per visit after deductible
Advanced imaging (MRI / CT / PET)	$200 copay after deductible (office, freestanding radiology center, or outpatient hospital)
Laboratory tests	$100 copay after deductible (office, freestanding lab, or outpatient hospital)
X-ray / diagnostic imaging	$100 copay after deductible (office, freestanding radiology center, or outpatient hospital)
Physical / occupational / speech therapy (cost and limit)	$50 copay; deductible does not apply (office and outpatient hospital). Limit: 60 days combined per benefit period
Chiropractic (cost and limit)	Manipulation therapy: $50 copay; deductible does not apply. Limit: 40 visits per benefit period
Acupuncture	$50 copay; deductible does not apply (no visit limit stated)
Mental health / substance use — outpatient, office visits	$50 copay (virtual and office); deductible does not apply
Mental health / substance use — outpatient, facility	Facility fees $200 copay after deductible; doctor services $100 copay after deductible
Mental health / substance use — inpatient	Covered under the Hospital benefit, which includes mental health and substance use services: facility $1,000 copay per admission after deductible; physician $100 copay after deductible
Prescription Tier 1 (retail, 30-day)	$20 copay per prescription
Prescription Tier 2 (retail, 30-day)	$40 copay per prescription
Prescription Tier 3 (retail, 30-day)	$100 copay per prescription
Prescription Tier 4 (retail, 30-day)	$150 copay per prescription (retail and home delivery)
Prescription mail order	Home delivery, 90-day supply: Tier 1 $30, Tier 2 $60, Tier 3 $150, Tier 4 $150. (A 90-day supply at a Retail 90 pharmacy costs 2× the 30-day retail copay.)
Prescription deductible	Not applicable — no pharmacy deductible (out-of-network pharmacy: not covered)
Home health (cost and limit)	$50 copay per visit; deductible does not apply. Limit: 100 visits per benefit period
Skilled nursing (cost and limit)	$50 copay per admission; deductible does not apply. Limit: 100 days per benefit period
Durable medical equipment (DME)	$50 copay; deductible does not apply

Source: official plan summary PDF posted by the County — Anthem Blue Cross “Your summary of benefits”: Custom EPO 1000 (plan code dated 01-01-2027).

Anthem HDPPO 3500 — “Anthem PPO (HSA) 3500”

HSA-compatible plan on Anthem’s Prudent Buyer PPO network. In-network, the $3,500 / $6,000 deductible is also the out-of-pocket maximum.

Anthem HDPPO 3500 — member cost of service, Plan Year 2027
Service	What you pay
Annual deductible (individual / family)	$3,500 / $6,000 — same in- and out-of-network; the two deductibles accumulate toward each other
Medical out-of-pocket maximum (individual / family)	In-network $3,500 / $6,000; out-of-network $5,000 / $10,000 — the two networks’ out-of-pocket limits accumulate separately
Pharmacy out-of-pocket maximum (individual / family)	Combined with the medical out-of-pocket limit (no separate pharmacy limit)
Primary care	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Specialist	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Preventive care	No charge (in-network); 50% coinsurance after deductible (out-of-network)
Telehealth / virtual visits	Virtual-care-only providers (app/website): primary care and mental health & substance use No charge (deductible does not apply); specialist No charge after deductible
Urgent care	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Emergency room — facility	No charge after deductible (out-of-network emergency care covered as in-network)
Emergency room — physician	No charge after deductible (out-of-network covered as in-network)
Ambulance	No charge after deductible (out-of-network covered as in-network)
Outpatient surgery — facility	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Outpatient surgery — physician / surgeon	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Inpatient hospital — facility	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Inpatient hospital — physician	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Advanced imaging (MRI / CT / PET)	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Laboratory tests	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
X-ray / diagnostic imaging	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Physical / occupational / speech therapy (cost and limit)	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network). No day limit stated in the summary
Chiropractic (cost and limit)	Manipulation therapy: No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network). Limit: 24 visits per benefit period
Acupuncture	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network). Limit: 12 visits per benefit period
Mental health / substance use — outpatient, office visits	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Mental health / substance use — outpatient, facility	Facility fees and doctor services: No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Mental health / substance use — inpatient	Covered under the Hospital benefit, which includes mental health and substance use services: No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)
Prescription Tier 1 (retail, 30-day)	0% coinsurance after deductible is met (retail and home delivery)
Prescription Tier 2 (retail, 30-day)	0% coinsurance after deductible is met (retail and home delivery)
Prescription Tier 3 (retail, 30-day)	0% coinsurance after deductible is met (retail and home delivery)
Prescription Tier 4 (retail, 30-day)	0% coinsurance after deductible is met (retail and home delivery)
Prescription mail order	Home delivery, 90-day supply: 0% coinsurance after deductible, all tiers. (A 90-day supply at a Retail 90 pharmacy costs 3× the 30-day cost share.)
Prescription deductible	Combined with the in-network medical deductible (no separate pharmacy deductible; out-of-network pharmacy: not covered)
Home health (cost and limit)	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network). Limit: 100 visits per benefit period
Skilled nursing (cost and limit)	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network). Limit: 100 days per benefit period
Durable medical equipment (DME)	No charge after deductible (in-network); 50% coinsurance after deductible (out-of-network)

Source: official plan summary PDF posted by the County — Anthem Blue Cross “Your summary of benefits”: Anthem PPO (HSA) 3500 (plan code dated 01-01-2027).

Kaiser HMO — “Kaiser Permanente DHMO” on 2027 county sheets

Kaiser’s “Disclosure Form Part One” for the Deductible HMO Plan (Group ID 580), which Kaiser identifies as a grandfathered health plan.

Kaiser HMO — member cost of service, Plan Year 2027
Service	What you pay
Annual deductible (individual / family)	$500 / $1,000 (family coverage: $500 per member, $1,000 per family)
Medical out-of-pocket maximum (individual / family)	$3,750 / $7,500 (family coverage: $3,750 per member, $7,500 per family)
Pharmacy out-of-pocket maximum (individual / family)	Not separately stated in the 2027 Kaiser summary
Primary care	$25 per visit; deductible does not apply (covers most primary care visits and most non-physician specialist visits)
Specialist	$50 per visit (most physician specialist visits); deductible does not apply. Most non-physician specialist visits are $25 (see primary care row)
Preventive care	No charge; deductible does not apply (routine physical maintenance and well-woman exams, well-child exams, most immunizations, preventive X-rays/screenings/labs)
Telehealth / virtual visits	No charge — primary care, non-physician specialist, and physician specialist visits by interactive video or telephone; deductible does not apply
Urgent care	$25 per visit; deductible does not apply
Emergency room — facility	$250 per visit after Plan Deductible — single emergency department charge, see note †
Emergency room — physician	Not split — included in the single charge in the row above †
Ambulance	No charge after Plan Deductible
Outpatient surgery — facility	$250 per procedure after Plan Deductible — single outpatient surgery charge, see note †
Outpatient surgery — physician / surgeon	Not split — included in the single charge in the row above †
Inpatient hospital — facility	$500 per admission after Plan Deductible — single inpatient charge, see note † (includes room and board, surgery, anesthesia, X-rays, laboratory tests, and drugs)
Inpatient hospital — physician	Not split — included in the single charge in the row above †
Advanced imaging (MRI / CT / PET)	$100 per procedure after Plan Deductible
Laboratory tests	$15 per encounter after Plan Deductible
X-ray / diagnostic imaging	$50 per encounter after Plan Deductible
Physical / occupational / speech therapy (cost and limit)	$25 per visit after Plan Deductible. No visit/day limit stated in the summary
Chiropractic (cost and limit)	$10 per visit (ASH participating providers; 2027 chiropractic amendment). Limit: 30 visits per 12-month period. Covered chiropractic X-rays and labs: No charge. Chiropractic supports and appliances: amounts in excess of a $50 allowance
Acupuncture	No acupuncture line in the 2027 Kaiser summary documents
Mental health / substance use — outpatient, office visits	Individual evaluation and treatment: $25 per visit (mental health and substance use). Group treatment: $12 per visit (mental health), $5 per visit (substance use). Deductible does not apply
Mental health / substance use — outpatient, facility	No separate outpatient facility charge line in the Kaiser summary — outpatient mental health / substance use care is priced under the office-visit lines above
Mental health / substance use — inpatient	Inpatient psychiatric hospitalization: $500 per admission after Plan Deductible. Inpatient detoxification: $500 per admission after Plan Deductible
Prescription Tier 1 (retail, 30-day)	$10 for up to a 30-day supply; deductible does not apply
Prescription Tier 2 (retail, 30-day)	$20 for up to a 30-day supply (“most brand-name items”); deductible does not apply
Prescription Tier 3 (retail, 30-day)	No Tier 3 line — the Kaiser summary prices Tier 1 (most generic), Tier 2 (most brand-name), and Tier 4 (most specialty) only
Prescription Tier 4 (retail, 30-day)	$150 for up to a 30-day supply; deductible does not apply
Prescription mail order	Mail-order refills, 100-day supply: Tier 1 $20, Tier 2 $40. A specialty (Tier 4) mail-order price is not stated in the summary
Prescription deductible	Drug Deductible: None
Home health (cost and limit)	No charge; deductible does not apply. Limit: 100 visits per Accumulation Period
Skilled nursing (cost and limit)	No charge after Plan Deductible. Limit: 100 days per benefit period
Durable medical equipment (DME)	No charge; deductible does not apply

Source: official plan summary PDF posted by the County — Kaiser Foundation Health Plan, Inc. “Disclosure Form Part One,” Group ID 580 — DHMO Plan (plan period 12/21/26–12/19/27). Chiropractic: 2027 Disclosure Form Amendment for Chiropractic Services (ASH Plans, dated August 24, 2026).

Kaiser HDHP — “DHMO HSA” on 2027 county sheets

Kaiser’s “Disclosure Form Part One” for the HSA-Qualified High Deductible Health Plan (HMO).

Kaiser HDHP — member cost of service, Plan Year 2027
Service	What you pay
Annual deductible (individual / family)	$3,500 / $6,000 (family coverage: $3,500 per member, $6,000 per family)
Medical out-of-pocket maximum (individual / family)	$3,500 / $6,000 — identical to the deductible, so the plan pays 100% of covered services once the deductible is met
Pharmacy out-of-pocket maximum (individual / family)	Not separately stated in the 2027 Kaiser summary
Primary care	No charge after Plan Deductible
Specialist	No charge after Plan Deductible
Preventive care	No charge; deductible does not apply (same preventive list as the Kaiser HMO)
Telehealth / virtual visits	No charge after Plan Deductible (primary care, non-physician specialist, and physician specialist video/telephone visits)
Urgent care	No charge after Plan Deductible
Emergency room — facility	No charge after Plan Deductible — single emergency department charge, see note †
Emergency room — physician	Not split — included in the single charge in the row above †
Ambulance	No charge after Plan Deductible
Outpatient surgery — facility	No charge after Plan Deductible — single outpatient surgery charge, see note †
Outpatient surgery — physician / surgeon	Not split — included in the single charge in the row above †
Inpatient hospital — facility	No charge after Plan Deductible — single inpatient charge, see note †
Inpatient hospital — physician	Not split — included in the single charge in the row above †
Advanced imaging (MRI / CT / PET)	No separate MRI/CT/PET line in the HDHP summary — X-rays and laboratory tests are priced on one combined line (see the two rows below)
Laboratory tests	No charge after Plan Deductible (combined “most X-rays and laboratory tests” line)
X-ray / diagnostic imaging	No charge after Plan Deductible (combined “most X-rays and laboratory tests” line)
Physical / occupational / speech therapy (cost and limit)	No charge after Plan Deductible. No visit/day limit stated in the summary
Chiropractic (cost and limit)	No charge after Plan Deductible (ASH participating providers; 2027 chiropractic amendment). Limit: 20 visits per 12-month period. Covered chiropractic X-rays/labs and supports/appliances: No charge after Plan Deductible
Acupuncture	No acupuncture line in the 2027 Kaiser summary documents
Mental health / substance use — outpatient, office visits	No charge after Plan Deductible (individual and group, mental health and substance use)
Mental health / substance use — outpatient, facility	No separate outpatient facility charge line in the Kaiser summary — outpatient mental health / substance use care is priced under the office-visit lines above
Mental health / substance use — inpatient	Inpatient psychiatric hospitalization and inpatient detoxification: No charge after Plan Deductible
Prescription Tier 1 (retail, 30-day)	No charge after Plan Deductible (priced for up to a 100-day supply — see mail-order row)
Prescription Tier 2 (retail, 30-day)	No charge after Plan Deductible (priced for up to a 100-day supply — see mail-order row)
Prescription Tier 3 (retail, 30-day)	No Tier 3 line — the Kaiser summary prices Tier 1 (most generic), Tier 2 (most brand-name), and Tier 4 (most specialty) only
Prescription Tier 4 (retail, 30-day)	No charge after Plan Deductible (up to a 30-day supply)
Prescription mail order	Tiers 1 and 2 are priced for up to a 100-day supply at a Plan Pharmacy or through mail order — No charge after Plan Deductible either way; no separate mail-order price
Prescription deductible	Drug Deductible: Not applicable (drugs are subject to the Plan Deductible)
Home health (cost and limit)	No charge after Plan Deductible. Limit: 100 visits per Accumulation Period
Skilled nursing (cost and limit)	No charge after Plan Deductible. Limit: 100 days per benefit period
Durable medical equipment (DME)	No charge after Plan Deductible (base DME; supplemental DME, up to a $2,500 benefit limit per Accumulation Period, is also No charge after Plan Deductible)

Source: official plan summary PDF posted by the County — Kaiser Foundation Health Plan, Inc. “Disclosure Form Part One,” Group ID 580 — DHMO HSA Plan (plan period 12/21/26–12/19/27). Chiropractic: 2027 Disclosure Form Amendment for Chiropractic Services (ASH Plans, dated August 24, 2026).

Notes on this section

† Kaiser does not split facility and physician charges. Emergency care, outpatient surgery, and inpatient hospital care each carry a single member charge in the Kaiser summaries (the inpatient charge expressly includes room and board, surgery, anesthesia, X-rays, laboratory tests, and drugs). Kaiser also notes that a member admitted directly from the emergency department pays the inpatient cost share instead of the emergency department cost share.
Mail-order supply lengths differ by carrier. Kaiser mail-order refills are priced for up to a 100-day supply; Anthem home delivery is a 90-day supply. Anthem retail pharmacies fill a 30-day supply (90 days at designated “Retail 90” pharmacies, at the multiples shown in the mail-order row).
Anti-obesity / GLP-1 drugs: “Anti-obesity/GLP-1 coverage was removed from the Anthem plans for 2027 per SJVIA's August 21, 2026 board action; the plan summaries themselves do not list these drugs (formulary governs).”

The Paper Trail

The 2027 renewal didn’t come down because the County paid more. It came down because coverage was cut. Here is the public record, document by document — every entry links to its source.

May 30, 2025

SJVIA’s board orders a competitive search for its benefits consultant. Keenan & Associates had held the job since 2017, at $24,000 a month. Source: SJVIA staff report, May 1, 2026 (PDF)
March 17, 2026

The County Board suspends competitive solicitation of the 2027 health plan proposals themselves. This is an annual step — the same action was taken for Plan Year 2026. Source: Board of Supervisors agenda, Item 26 (PDF)
May 1, 2026

USI wins the SJVIA consulting contract through the RFP — four proposals received; Keenan, USI, and Milliman interviewed as finalists. The award: $2,300,000, June 1, 2026 through December 31, 2031, by unanimous vote. Source: SJVIA staff report (PDF) Executed agreement (PDF)
July 17, 2026

The preliminary 2027 renewal lands: +29.2% overall. In the meeting record, SEIU Local 521’s representative calls “an approximate 29% increase in health care costs” unsustainable. Source: SJVIA staff report, Item 13 (PDF)
August 21, 2026

The final Anthem renewal is approved at +16.55% — and the packet shows how the number came down: “Removal of Anti-Obesity Medication (AOM/GLP-1) coverage from Anthem medical plans. Elimination of the Yosemite EPO $0 plan. Modification of the Sierra and Pismo plans, including the addition of deductibles, adjustment of copays, and increased specialty pharmacy cost sharing.” Kaiser’s plans kept GLP-1 coverage. Source: SJVIA board packet, August 21, 2026 (PDF)

The County’s 2027 enrollment materials present the restructured Sierra and Pismo designs as the Cypress and Maple plans priced in What Care Costs above.
September 8, 2026

Kaiser’s renewal is approved (+4.92% across SJVIA), completing the 2027 medical renewal. Source: SJVIA special meeting packet (PDF)
October 6, 2026

The County Board approves the 2027 premiums. What the County itself will contribute — the number that decides your paycheck deduction — is not set in public. It is negotiated with the unions in closed session. Source: Board of Supervisors agenda, Items 9 and 19 (PDF)
October 26, 2026

The County presents a revised proposed contribution at the bargaining table. The proposal — an MOU addendum for SEIU Local 521 Units 3, 4, 12, 22 & 36 and a session rate sheet (“Rates approved by BOS on October 6, 2026 — County contribution pending approval”) — sets the biweekly contribution at $460 (Employee Only), $1,007 (Employee + Spouse), $871 (Employee + Child(ren)), and $1,415 (Family), effective the pay period beginning December 21, 2026. It is a proposal pending approval, not a final agreement, and the deduction tables on this page now reflect it. Source: documents presented at the October 26, 2026 bargaining session
Now

The County is re-bidding its own benefits consultant (RFP 26-074). Its stated reason: USI now advises SJVIA, and the County wants an independent consulting partner to give it objective guidance in the County’s own interests. Source: Fresno County RFP 26-074

What you won’t find: minutes of the bargaining sessions themselves. California’s Meyers-Milias-Brown Act keeps meet-and-confer negotiations behind closed doors — the public sees the outcomes, not the talks. Every document above is a public record, and you can request more: Fresno County public records requests; SJVIA records requests go to the SJVIA Manager through the County.

The records are public. The responsibility is orphaned.

For Hospitals, Clinics & Care Teams

Fresno County is one of the region’s largest employers, and county employees and their families are your patients. The 2027 numbers on this page land in your facilities long before they land anywhere else — as the follow-up that gets postponed, the prescription that gets split, and the family member who quietly drops off a plan during open enrollment.

What the data means for patient access

Under the County’s October 26, 2026 proposal, the two high-deductible family plans carry a $0 premium — their cost is a $3,500 / $6,000 deductible — while the most expensive family plan (Kaiser HMO) costs an employee $411.50 every two weeks — $10,699 a year — before a single claim is filed. At midpoint pay, 125 of the County’s 132 job classifications pay more than the IRS affordability threshold (10.22% of pay) for that plan; on the median-priced family plan (Anthem EPO Maple, $163.21 per pay period), 3 of 132 do.
When coverage costs cross what a paycheck can carry, open enrollment — which closes November 20, 2026 — is when families make the trade: a cheaper plan with a higher deductible, or no family coverage at all. Either way, the care doesn’t disappear. It arrives later, sicker, and harder to pay for.
These are the County’s own figures: the County’s October 26, 2026 proposed contribution, the deduction tables presented at that session, and the San Joaquin Valley Insurance Authority (SJVIA) 2027 renewals, including the Anthem plan’s +21.24% renewal. Figures are a proposal, pending approval, until the County publishes final tables; this page will be updated when it does.

How care teams can use this page

Financial counselors and patient-access staff: the calculator above prices every plan and tier for each of the County’s 132 job classifications at entry, midpoint, and top pay steps. It takes about a minute and flags when a cost crosses the federal affordability threshold — a useful starting point for coverage conversations during open enrollment.
Medical social workers and care coordinators: if a patient’s treatment plan depends on a spouse’s or parent’s county coverage, this page shows what that coverage will actually cost the household in 2027, so discharge and follow-up plans can be built on real numbers.
Community benefit and community health teams: Fresno’s own community health needs assessments rank access to care among the county’s top priorities. Sharing these numbers with the county employees in your waiting rooms is a low-cost way to act on that priority before the November 20 deadline.

Downloads

Waiting-room flyer (PDF, one page)

Prints cleanly in black and white; suitable for waiting rooms, financial-counseling offices, and staff break rooms. A provider outreach letter is available on request.

Every figure on this page comes from a public document — Fresno County Employee Benefits open-enrollment materials and SJVIA renewal documents — and each table carries its source line. This site is an independent information project: it is not a Fresno County website, it is not affiliated with the County or SJVIA, and it collects no data. All calculations happen in the visitor’s own browser.

Email the Board

The Board of Supervisors sets the County’s contribution. This tool drafts a short, factual email using your own numbers. Nothing is sent by this site. The draft is built in your browser; the button below hands it to your own email app, addressed to the recipient you choose — your own district supervisor, all five supervisors, or the Clerk of the Board — and you review and send it yourself. You can also copy the text and send it any other way you like.

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Open in my email

You choose the recipient above. The Fresno County Board of Supervisors: District 1 — Brian Pacheco, District1@fresnocountyca.gov; District 2 — Garry Bredefeld (Chairman), District2@fresnocountyca.gov; District 3 — Luis Chavez (Vice Chairman), District3@fresnocountyca.gov; District 4 — Ernest “Buddy” Mendes, District4@fresnocountyca.gov; District 5 — Nathan Magsig, District5@fresnocountyca.gov. Or send it to the Clerk of the Board of Supervisors, ClerkBOS@fresnocountyca.gov — the email address the County publishes for Board correspondence (County of Fresno, Board of Supervisors proclamation request form, fresnocountyca.gov). Supervisor names and emails verified Oct 21, 2026 from fresnocountyca.gov. The draft is generated fresh on this page each time; this site keeps no copy.

Key Dates & Updates

October 19, 2026

Open enrollment for Plan Year 2027 opened, with preliminary deduction tables published by the County.
October 23, 2026

New on this page: cost-of-service detail for all five Plan Year 2027 plans — deductibles, copays, therapy and chiropractic limits, and prescription tiers — transcribed from the County’s published 2027 plan documents.
Monday, October 26, 2026

Bargaining session on the County’s 2027 health contribution. The County presented a revised proposed contribution — $460 / $1,007 / $871 / $1,415 by tier — pending approval, and the contribution and deduction tables on this page were updated to that proposal.
Friday, November 20, 2026 — 5:00 PM

Open enrollment closes. Make your Plan Year 2027 election before the deadline.
When final numbers publish

This page will be updated when the County and SJVIA publish the final 2027 contribution and deduction figures. Every table above will keep its source and its “preliminary” stamp until then.

What Fresno County health coverage costs in 2027 — in the County’s and SJVIA’s own numbers.