| HEALTH INSURANCE RATES | ||||
| MSA TABLES | ||||
| Bi-Weekly Period End Date 6/5/97 Payable 6/20/97 | ||||
| Semi-Monthly Period End Date 6/30/97 Payable 6/30/97 | ||||
| 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 | 17.40 | 011 | 93.85 |
| Subscriber + One | 012 | 58.96 | 013 | 185.79 |
| Family | 014 | 70.02 | 015 | 230.35 |
| FLES | 018 | 39.06 | 019 | 150.06 |
| 24 Pay Semi-monthly | ||||
| Individual | 216 | 18.85 | 217 | 101.67 |
| Subscriber + One | 218 | 63.87 | 219 | 201.27 |
| Family | 220 | 75.85 | 221 | 249.55 |
| FLES | 224 | 42.32 | 225 | 162.56 |
| 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 | 8.85 |
| Family | 178 | 5.46 | 179 | 21.58 |
| FLES | 180 | 2.80 | 181 | 15.39 |
| 24 Pay Semi-monthly | ||||
| Individual | 382 | 0.00 | 383 | 9.59 |
| Family | 384 | 5.91 | 385 | 23.38 |
| FLES | 386 | 3.03 | 387 | 16.67 |
| 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 | 2.36 | 043 | 8.85 |
| Family | 044 | 9.86 | 045 | 21.58 |
| FLES | 174 | 4.84 | 175 | 15.39 |
| 24 Pay Semi-monthly | ||||
| Individual | 248 | 2.55 | 246 | 9.59 |
| Family | 247 | 10.68 | 251 | 23.38 |
| FLES | 380 | 5.25 | 381 | 16.67 |
| Chart D | (PAIRED D/OEs 6R/6P PRE-TAX) (SORT CODE 00077) | |||
| BlueCare Point of Enrollment | (PAIRED D/OEs 6N/6P POST-TAX) (SORT CODE 00077) | |||
| 26 Pay Bi-weekly | ||||
| Individual | 046 | 0.00 | 047 | 91.11 |
| Subscriber + One | 048 | 21.87 | 049 | 178.58 |
| Family | 050 | 30.98 | 051 | 215.02 |
| FLES | 052 | 12.76 | 053 | 142.13 |
| 24 Pay Semi-monthly | ||||
| Individual | 252 | 0.00 | 253 | 98.71 |
| Subscriber + One | 254 | 23.69 | 255 | 193.46 |
| Family | 256 | 33.56 | 257 | 232.94 |
| FLES | 258 | 13.82 | 259 | 153.98 |
| 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 | 6.46 | 083 | 94.77 |
| Subscriber + One | 084 | 36.41 | 085 | 186.30 |
| Family | 086 | 42.98 | 087 | 230.35 |
| FLES | 088 | 16.12 | 089 | 155.98 |
| 24 Pay Semi-monthly | ||||
| Individual | 288 | 7.00 | 289 | 102.67 |
| Subscriber + One | 290 | 39.45 | 291 | 201.82 |
| Family | 292 | 46.56 | 293 | 249.55 |
| FLES | 294 | 17.46 | 295 | 168.98 |
| Chart F | (PAIRED D/OEs 6L/6J PRE-TAX) (SORT CODE 00006) | |||
| KaiserFoundation Health | (PAIRED D/OEs 6I/6J POST-TAX) (SORT CODE 00006) | |||
| 26 Pay Bi-weekly | ||||
| Individual | 126 | 0.00 | 127 | 82.74 |
| Subscriber + One | 128 | 0.00 | 129 | 183.85 |
| Family | 130 | 0.00 | 131 | 188.21 |
| FLES | 132 | 0.00 | 133 | 105.46 |
| 24 Pay Semi-monthly | ||||
| Individual | 332 | 0.00 | 333 | 89.64 |
| Subscriber + One | 334 | 0.00 | 335 | 199.17 |
| Family | 336 | 0.00 | 337 | 203.89 |
| FLES | 338 | 0.00 | 339 | 114.25 |
| Chart G | (PAIRED D/OEs 6W/6U PRE-TAX) (SORT CODE 00259) | |||
| M.D. Health Plan | (PAIRED D/OEs 6T/6U POST-TAX) (SORT CODE 00259) | |||
| 26 Pay Bi-weekly | ||||
| Individual | 116 | 0.00 | 117 | 85.47 |
| Subscriber + One | 118 | 21.87 | 119 | 166.17 |
| Family | 120 | 30.98 | 121 | 199.80 |
| FLES | 122 | 12.76 | 123 | 132.54 |
| 24 Pay Semi-monthly | ||||
| Individual | 260 | 0.00 | 261 | 92.60 |
| Subscriber + One | 262 | 23.69 | 263 | 180.02 |
| Family | 264 | 33.56 | 265 | 216.45 |
| FLES | 272 | 13.82 | 273 | 143.59 |
| 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 | 6.79 |
| Subscriber + One | 142 | 1.81 | 143 | 11.03 |
| Family | 144 | 3.49 | 145 | 14.95 |
| FLES | 146 | 1.46 | 147 | 10.19 |
| 24 Pay Semi-monthly | ||||
| Individual | 276 | 0.00 | 277 | 7.36 |
| Subscriber + One | 278 | 1.96 | 279 | 11.95 |
| Family | 280 | 3.79 | 281 | 16.19 |
| FLES | 282 | 1.58 | 283 | 11.04 |
| 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 | 6.46 | 135 | 104.79 |
| Subscriber + One | 124 | 36.41 | 125 | 208.34 |
| Family | 136 | 42.98 | 137 | 257.39 |
| FLES | 138 | 16.12 | 139 | 173.00 |
| 24 Pay Semi-monthly | ||||
| Individual | 344 | 7.00 | 345 | 113.52 |
| Subscriber + One | 340 | 39.45 | 341 | 225.69 |
| Family | 346 | 46.56 | 347 | 278.84 |
| FLES | 348 | 17.46 | 349 | 187.43 |
| Paired DO/E's = Paired deductions employee/state share required to allow state contribution to the cost of coverage |
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