| State Employee Health Insurance | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7/1/2008 TO 6/30/2009 RATES | |||||||||||||||||
| Monthly & Bi-Weekly Rates For Carrier Billing & Payment Purposes | |||||||||||||||||
| Medical Plans | Dental Plans | ||||||||||||||||
| Anthem | |||||||||||||||||
| Blue Cross | State BlueCare | Health Net | Oxford Health | United Health | CIGNA | ||||||||||||
| State Preferred | Out of Area | POS | POE | POE Plus | Charter POS | Charter HMO | Passport HMO | Freedom Select POS | HMO Select | HMO | Oxford USA Out of Area | Employees | Judges | PPO | DHMO | ||
| Individual | Total Monthly Premium | $ 709.78 | $ 680.14 | $ 502.40 | $ 486.97 | $ 485.13 | $ 526.73 | $ 496.46 | $ 502.17 | $ 437.37 | $ 417.10 | $ 385.23 | $ 462.69 | $ 35.33 | $ 36.20 | $ 32.50 | $ 21.58 |
| Monthly State Share | $ 599.98 | $ 649.49 | $ 471.75 | $ 470.35 | $ 473.51 | $ 494.60 | $ 479.27 | $ 489.98 | $ 410.69 | $ 404.67 | $ 377.80 | $ 436.01 | $ 35.33 | $ 35.33 | $ 32.50 | $ 21.58 | |
| Monthly Employee Share | $ 109.80 | $ 30.65 | $ 30.65 | $ 16.62 | $ 11.62 | $ 32.13 | $ 17.19 | $ 12.19 | $ 26.68 | $ 12.43 | $ 7.43 | $ 26.68 | $ - | $ 0.87 | $ - | $ - | |
| Medical Premium | $ 592.85 | $ 563.21 | $ 385.47 | $ 370.04 | $ 368.20 | $ 409.80 | $ 379.53 | $ 385.24 | $ 320.44 | $ 300.17 | $ 268.30 | $ 345.76 | |||||
| Monthly Rx Drug | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | $ 116.93 | |||||
| BW State Share Rx Drug | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | |||||
| BW State Share | $ 276.91 | $ 299.76 | $ 217.73 | $ 217.08 | $ 218.54 | $ 228.28 | $ 221.20 | $ 226.14 | $ 189.55 | $ 186.77 | $ 174.37 | $ 201.24 | $ 16.31 | $ 16.31 | $ 15.00 | $ 9.96 | |
| BW Employee Share | $ 50.68 | $ 14.15 | $ 14.15 | $ 7.67 | $ 5.36 | $ 14.83 | $ 7.93 | $ 5.63 | $ 12.31 | $ 5.74 | $ 3.43 | $ 12.31 | $ - | $ 0.40 | $ - | $ - | |
| Subscriber + 1 | Total Monthly Premium | $ 1,561.52 | $ 1,496.31 | $ 1,105.28 | $1,071.33 | $ 1,067.29 | $ 1,158.81 | $ 1,092.21 | $ 1,104.77 | $ 962.21 | $ 917.62 | $ 847.51 | $ 1,017.92 | $ 107.76 | $110.05 | $ 99.13 | $ 47.48 |
| Monthly State Share | $ 1,189.41 | $ 1,323.55 | $ 932.52 | $ 963.66 | $ 977.96 | $ 977.69 | $ 982.44 | $ 1,012.30 | $ 811.82 | $ 825.40 | $ 776.57 | $ 867.53 | $ 86.03 | $ 86.03 | $ 79.14 | $ 39.71 | |
| Monthly Employee Share | $ 372.11 | $ 172.76 | $ 172.76 | $ 107.67 | $ 89.33 | $ 181.12 | $ 109.77 | $ 92.47 | $ 150.39 | $ 92.22 | $ 70.94 | $ 150.39 | $ 21.73 | $ 24.02 | $ 19.99 | $ 7.77 | |
| Medical Premium | $ 1,304.27 | $ 1,239.06 | $ 848.03 | $ 814.09 | $ 810.04 | $ 901.56 | $ 834.97 | $ 847.53 | $ 704.97 | $ 660.37 | $ 590.26 | $ 760.67 | |||||
| Monthly Rx Drug | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | $ 257.25 | |||||
| BW State Share Rx Drug | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | |||||
| BW State Share | $ 548.96 | $ 610.87 | $ 430.39 | $ 444.77 | $ 451.37 | $ 451.24 | $ 453.43 | $ 467.22 | $ 374.69 | $ 380.95 | $ 358.42 | $ 400.40 | $ 39.71 | $ 39.71 | $ 36.53 | $ 18.33 | |
| BW Employee Share | $ 171.74 | $ 79.74 | $ 79.74 | $ 49.69 | $ 41.23 | $ 83.59 | $ 50.66 | $ 42.68 | $ 69.41 | $ 42.56 | $ 32.74 | $ 69.41 | $ 10.03 | $ 11.09 | $ 9.23 | $ 3.59 | |
| Family | Total Monthly Premium | $ 1,916.41 | $ 1,836.38 | $ 1,356.48 | $ 1,314.82 | $ 1,309.85 | $1,422.17 | $ 1,340.44 | $ 1,355.86 | $ 1,180.90 | $ 1,126.17 | $ 1,040.12 | $ 1,249.26 | $ 107.76 | $110.05 | $ 99.13 | $ 58.27 |
| Monthly State Share | $ 1,474.49 | $ 1,632.50 | $ 1,152.60 | $ 1,162.30 | $ 1,186.99 | $ 1,208.42 | $ 1,184.95 | $ 1,228.68 | $ 1,003.41 | $ 995.53 | $ 942.56 | $ 1,071.77 | $ 86.03 | $ 86.03 | $ 79.14 | $ 47.26 | |
| Monthly Employee Share | $ 441.92 | $ 203.88 | $ 203.88 | $ 152.52 | $ 122.86 | $ 213.75 | $ 155.49 | $ 127.18 | $ 177.49 | $ 130.64 | $ 97.56 | $ 177.49 | $ 21.73 | $ 24.02 | $ 19.99 | $ 11.01 | |
| Medical Premium | $ 1,600.70 | $ 1,520.67 | $ 1,040.77 | $ 999.11 | $ 994.14 | $ 1,106.46 | $ 1,024.73 | $ 1,040.15 | $ 865.19 | $ 810.46 | $ 724.41 | $ 933.55 | |||||
| Monthly Rx Drug | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | $ 315.71 | |||||
| BW State Share Rx Drug | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | |||||
| BW State Share | $ 680.53 | $ 753.46 | $ 531.97 | $ 536.45 | $ 547.84 | $ 557.73 | $ 546.90 | $ 567.08 | $ 463.11 | $ 459.48 | $ 435.03 | $ 494.66 | $ 39.71 | $ 39.71 | $ 36.53 | $ 21.81 | |
| BW Employee Share | $ 203.96 | $ 94.10 | $ 94.10 | $ 70.39 | $ 56.70 | $ 98.65 | $ 71.76 | $ 58.70 | $ 81.92 | $ 60.30 | $ 45.03 | $ 81.92 | $ 10.03 | $ 11.09 | $ 9.23 | $ 5.08 | |
| FLES | Total Monthly Premium | $ 1,206.63 | $ 1,156.24 | $ 854.08 | $ 827.85 | $ 824.72 | $ 895.44 | $ 843.98 | $ 853.69 | $ 743.53 | $ 709.07 | $ 654.89 | $ 786.57 | $ 72.43 | $ 73.85 | $ 66.63 | $ 36.69 |
| Monthly State Share | $ 959.99 | $ 1,079.71 | $ 777.55 | $ 765.02 | $ 774.16 | $ 815.21 | $ 779.92 | $ 801.36 | $ 676.91 | $ 655.25 | $ 614.75 | $ 719.95 | $ 61.30 | $ 61.30 | $ 56.39 | $ 32.16 | |
| Monthly Employee Share | $ 246.64 | $ 76.53 | $ 76.53 | $ 62.83 | $ 50.56 | $ 80.23 | $ 64.06 | $ 52.33 | $ 66.62 | $ 53.82 | $ 40.14 | $ 66.62 | $ 11.13 | $ 12.55 | $ 10.24 | $ 4.53 | |
| Medical Premium | $ 1,007.85 | $ 957.46 | $ 655.30 | $ 629.07 | $ 625.94 | $ 696.66 | $ 645.20 | $ 654.91 | $ 544.75 | $ 510.29 | $ 456.11 | $ 587.79 | |||||
| Monthly Rx Drug | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | $ 198.78 | |||||
| BW State Share Rx Drug | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | $ 91.74 | |||||
| BW State Share | $ 443.07 | $ 498.33 | $ 358.87 | $ 353.09 | $ 357.30 | $ 376.25 | $ 359.96 | $ 369.86 | $ 312.42 | $ 302.42 | $ 283.73 | $ 332.28 | $ 28.29 | $ 28.29 | $ 26.03 | $ 14.84 | |
| BW Employee Share | $ 113.83 | $ 35.32 | $ 35.32 | $ 29.00 | $ 23.34 | $ 37.03 | $ 29.57 | $ 24.15 | $ 30.75 | $ 24.84 | $ 18.53 | $ 30.75 | $ 5.14 | $ 5.79 | $ 4.73 | $ 2.09 | |
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