| State Employee Health Insurance | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7/1/2008 TO 6/30/2009 RATES - BI-WEEKLY SCHEDULE - 100% of Premium | ||||||||||||||||
| SPLIT RATES | ||||||||||||||||
| 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 | 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 | $ 32.50 | $ 21.58 |
| Monthly 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 | ||||
| BiWeekly Total Premium | $ 327.59 | $ 313.91 | $ 231.88 | $ 224.76 | $ 223.91 | $ 243.11 | $ 229.14 | $ 231.77 | $ 201.87 | $ 192.51 | $ 177.80 | $ 213.55 | $ 16.31 | $ 15.00 | $ 9.96 | |
| BiWeekly Medical Premium | $ 273.62 | $ 259.94 | $ 177.91 | $ 170.79 | $ 169.94 | $ 189.14 | $ 175.17 | $ 177.80 | $ 147.90 | $ 138.54 | $ 123.83 | $ 159.58 | ||||
| BiWeekly Rx Premium | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | $ 53.97 | ||||
| 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 | $ 99.13 | $ 47.48 |
| Monthly 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 | $ 257.24 | $ 257.25 | $ 257.25 | $ 257.24 | $ 257.24 | $ 257.24 | $ 257.25 | $ 257.25 | $ 257.25 | ||||
| BiWeekly Total Premium | $ 720.70 | $ 690.60 | $ 510.13 | $ 494.46 | $ 492.59 | $ 534.83 | $ 504.10 | $ 509.90 | $ 444.10 | $ 423.52 | $ 391.16 | $ 469.81 | $ 49.74 | $ 45.75 | $ 21.91 | |
| BiWeekly Medical Premium | $ 601.97 | $ 571.87 | $ 391.40 | $ 375.73 | $ 373.86 | $ 416.10 | $ 385.37 | $ 391.17 | $ 325.37 | $ 304.79 | $ 272.43 | $ 351.08 | ||||
| BiWeekly Rx Premium | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | $ 118.73 | ||||
| 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 | $ 99.13 | $ 58.27 |
| Monthly 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 | ||||
| BiWeekly Total Premium | $ 884.50 | $ 847.56 | $ 626.07 | $ 606.84 | $ 604.55 | $ 656.39 | $ 618.66 | $ 625.78 | $ 545.03 | $ 519.77 | $ 480.06 | $ 576.58 | $ 49.74 | $ 45.75 | $ 26.89 | |
| BiWeekly Medical Premium | $ 738.78 | $ 701.85 | $ 480.36 | $ 461.13 | $ 458.83 | $ 510.67 | $ 472.95 | $ 480.07 | $ 399.32 | $ 374.06 | $ 334.34 | $ 430.87 | ||||
| BiWeekly Rx Premium | $ 145.72 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.72 | $ 145.72 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.71 | $ 145.72 | $ 145.71 | ||||
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