Attachment to:
Comptroller's Memorandum 2001-29
Rate
Charts A-N
April 30, 2001
MSA TABLES 7/1/2001 TO 6/30/2002 RATES |
||||
TABLE NO. |
EMPLOYEE DEDUCTION |
TABLE NO. |
STATE PORTION |
|
Chart A | (PAIRED D/OEs 7J/7H PRE-TAX) (SORT CODE 00001) | |||
Blue Cross State Preferred |
(PAIRED D/OEs 7G/7H POST-TAX) (SORT CODE 00001) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 010 | 27.96 | 011 | 152.78 |
SUBSCRIBER + ONE | 012 | 94.76 | 013 | 302.87 |
FAMILY | 014 | 112.53 | 015 | 375.48 |
FLES | 018 | 62.81 | 019 | 244.45 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 216 | 30.29 | 217 | 165.52 |
SUBSCRIBER + ONE | 218 | 102.66 | 219 | 328.11 |
FAMILY | 220 | 121.91 | 221 | 406.76 |
FLES | 224 | 68.04 | 225 | 264.83 |
CHART B | (PAIRED D/OEs 5P/54 PRE-TAX) (SORT CODE 00159) | |||
Blue Cross Dental w/A&C |
(PAIRED D/OEs 42/54 POST-TAX) (SORT CODE 00159) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 176 | 0.00 | 177 | 11.53 |
FAMILY | 178 | 7.11 | 179 | 28.11 |
FLES | 180 | 3.65 | 181 | 20.04 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 382 | 0.00 | 383 | 12.49 |
FAMILY | 384 | 7.70 | 385 | 30.45 |
FLES | 386 | 3.95 | 387 | 21.71 |
CHART C | (PAIRED D/OEs 5P/54 PRE-TAX) (SORT CODE 00159) | |||
Blue Cross Dental w/A,B,&C |
(PAIRED D/OEs 42/54 POST-TAX) (SORT CODE 00159) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 042 | 3.06 | 043 | 11.53 |
FAMILY | 044 | 12.83 | 045 | 28.11 |
FLES | 174 | 6.31 | 175 | 20.04 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 248 | 3.32 | 246 | 12.49 |
FAMILY | 247 | 13.90 | 251 | 30.45 |
FLES | 380 | 6.83 | 381 | 21.71 |
CHART D | (PAIRED D/OEs 6R/6P PRE-TAX) (SORT CODE 00079) | |||
BlueCare POE |
(PAIRED D/OEs 6N/6P POST-TAX) (SORT CODE 00079) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 046 | 1.42 | 047 | 119.14 |
SUBSCRIBER + ONE | 048 | 26.65 | 049 | 238.58 |
FAMILY | 050 | 37.76 | 051 | 287.75 |
FLES | 052 | 15.55 | 053 | 189.40 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 252 | 1.54 | 253 | 129.07 |
SUBSCRIBER + ONE | 254 | 28.88 | 255 | 258.45 |
FAMILY | 256 | 40.91 | 257 | 311.72 |
FLES | 258 | 16.85 | 259 | 205.18 |
CHART E | (PAIRED D/OEs 7U/7S PRE-TAX) (SORT CODE 00077) | |||
BlueCare Point of Service |
(PAIRED D/OEs 7R/7S POST-TAX) (SORT CODE 00077) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 082 | 7.75 | 083 | 119.3 |
SUBSCRIBER + ONE | 084 | 43.68 | 085 | 235.82 |
FAMILY | 086 | 51.56 | 087 | 291.47 |
FLES | 088 | 19.35 | 089 | 196.63 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 288 | 8.40 | 289 | 129.24 |
SUBSCRIBER + ONE | 290 | 47.33 | 291 | 255.47 |
FAMILY | 292 | 55.86 | 293 | 315.75 |
FLES | 294 | 20.97 | 295 | 213.01 |
CHART F | (PAIRED D/OEs 6L/6J PRE-TAX) (SORT CODE 00006) | |||
ConnectiCare HMO Personal Care |
(PAIRED D/OEs 6I/6J POST-TAX) (SORT CODE 00006) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 763 | - | 764 | 103.76 |
SUBSCRIBER + ONE | 765 | 19.11 | 766 | 209.16 |
FAMILY | 767 | 26.28 | 768 | 253.87 |
FLES | 769 | 10.81 | 770 | 165.58 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 771 | - | 772 | 112.41 |
SUBSCRIBER + ONE | 773 | 20.70 | 774 | 226.59 |
FAMILY | 775 | 28.47 | 776 | 275.02 |
FLES | 777 | 11.72 | 778 | 179.37 |
CHART G | (PAIRED D/OEs 6W/6U PRE-TAX) (SORT CODE 00259) | |||
Health Net Charter HMO |
(PAIRED D/OEs 6T/6U POST-TAX) (SORT CODE 00259) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 116 | 1.85 | 117 | 125.92 |
SUBSCRIBER + ONE | 118 | 28.25 | 119 | 252.85 |
FAMILY | 120 | 40.02 | 121 | 304.97 |
FLES | 122 | 16.49 | 123 | 200.72 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 260 | 2.01 | 261 | 136.41 |
SUBSCRIBER + ONE | 262 | 30.605 | 263 | 273.91 |
FAMILY | 264 | 43.36 | 265 | 330.37 |
FLES | 272 | 17.86 | 273 | 217.46 |
CHART H | (PAIRED D/OEs 5R/5K PRE-TAX) (SORT CODE 00185) | |||
CIGNA Dental Health |
(PAIRED D/OEs 5J/5K POST-TAX) (SORT CODE 00185) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 140 | 0.00 | 141 | 7.36 |
SUBSCRIBER + ONE | 142 | 2.65 | 143 | 13.55 |
FAMILY | 144 | 3.76 | 145 | 16.12 |
FLES | 146 | 1.55 | 147 | 10.97 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 276 | 0.00 | 277 | 7.98 |
SUBSCRIBER + ONE | 278 | 2.87 | 279 | 14.68 |
FAMILY | 280 | 4.07 | 281 | 17.47 |
FLES | 282 | 1.67 | 283 | 11.89 |
CHART I | (PAIRED D/OEs 7P/7M PRE-TAX) (SORT CODE 00001) | |||
Blue Cross Out of Area Plan |
(PAIRED D/OEs 7L/7M POST-TAX) (SORT CODE 00001) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 134 | 7.75 | 135 | 168.56 |
SUBSCRIBER + ONE | 124 | 43.68 | 125 | 344.21 |
FAMILY | 136 | 51.56 | 137 | 424.48 |
FLES | 138 | 19.35 | 139 | 280.38 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 344 | 8.40 | 345 | 182.61 |
SUBSCRIBER + ONE | 340 | 47.33 | 341 | 372.88 |
FAMILY | 346 | 55.86 | 347 | 459.85 |
FLES | 348 | 20.97 | 349 | 303.74 |
CHART J | (PAIRED D/OEs 5A/5C PRE-TAX) (SORT CODE 00078) | |||
BlueCare POE Plus |
(PAIRED D/OEs 5B/5C POST-TAX) (SORT CODE 00078) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 266 | 0.00 | 267 | 115.13 |
SUBSCRIBER + ONE | 268 | 21.20 | 269 | 232.09 |
FAMILY | 270 | 29.16 | 271 | 281.69 |
FLES | 274 | 12.00 | 275 | 183.72 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 284 | 0.00 | 285 | 124.73 |
SUBSCRIBER + ONE | 286 | 22.97 | 287 | 251.43 |
FAMILY | 296 | 31.59 | 297 | 305.17 |
FLES | 298 | 13.00 | 299 | 199.04 |
CHART K | (PAIRED D/OEs 5F/5L PRE-TAX) (SORT CODE 00261) | |||
Health Net CHARTER POS |
(PAIRED D/OEs 5G/5L POST-TAX) (SORT CODE 00261) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 327 | 8.02 | 328 | 123.42 |
SUBSCRIBER + ONE | 329 | 45.19 | 330 | 243.97 |
FAMILY | 350 | 53.34 | 351 | 301.54 |
FLES | 352 | 20.02 | 353 | 203.42 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 354 | 8.69 | 355 | 133.70 |
SUBSCRIBER + ONE | 356 | 48.96 | 357 | 264.30 |
FAMILY | 358 | 57.79 | 359 | 326.66 |
FLES | 360 | 21.69 | 361 | 220.38 |
CHART L | (PAIRED D/OEs 5Q/5T PRE-TAX) (SORT CODE 00260) | |||
Health Net PASSPORT HMO |
(PAIRED D/OEs 5S/5T POST-TAX) (SORT CODE 00260) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 397 | 0.00 | 398 | 125.21 |
SUBSCRIBER + ONE | 399 | 23.05 | 400 | 252.40 |
FAMILY | 401 | 31.71 | 402 | 306.35 |
FLES | 403 | 13.05 | 404 | 199.80 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 405 | 0.00 | 406 | 135.64 |
SUBSCRIBER + ONE | 407 | 24.98 | 408 | 273.43 |
FAMILY | 409 | 34.35 | 410 | 331.88 |
FLES | 411 | 14.14 | 412 | 216.45 |
CHART M | (PAIRED D/OEs 8N/8L PRE-TAX) (SORT CODE 00052) | |||
CTCARE POS OPEN ACCESS |
(PAIRED D/OEs 8K/8L POST-TAX) (SORT CODE 00052) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 440 | 7.56 | 441 | 116.41 |
SUBSCRIBER + ONE | 442 | 42.63 | 443 | 230.11 |
FAMILY | 444 | 50.31 | 445 | 284.42 |
FLES | 446 | 18.88 | 447 | 191.88 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 448 | 8.20 | 449 | 126.11 |
SUBSCRIBER + ONE | 472 | 46.18 | 473 | 249.29 |
FAMILY | 474 | 54.50 | 475 | 308.12 |
FLES | 476 | 20.46 | 477 | 207.86 |
CHART N | (PAIRED D/OEs 8T/8R PRE-TAX) (SORT CODE 00054) | |||
CTCARE HMO OPEN ACCESS |
(PAIRED D/OEs 8Q/8R POST-TAX) (SORT CODE 00054) 26 PAY BI-WEEKLY |
|||
INDIVIDUAL | 524 | 1.13 | 525 | 114.53 |
SUBSCRIBER + ONE | 526 | 25.57 | 527 | 228.88 |
FAMILY | 528 | 36.22 | 529 | 276.05 |
FLES | 530 | 14.92 | 531 | 181.70 |
24 PAY SEMI-MONTHLY | ||||
INDIVIDUAL | 541 | 1.22 | 542 | 124.08 |
SUBSCRIBER + ONE | 543 | 27.71 | 544 | 247.94 |
FAMILY | 545 | 39.24 | 547 | 299.06 |
FLES | 548 | 16.17 | 549 | 196.83 |
Return to Comptroller's Memorandum 2001-29
Return to Index of 2001 Comptroller's Memoranda
Return to Index of Comptroller's Memoranda
Return to Comptroller's Home Page