MEMORANDUM NO. 97-22 Attachment 2
| Medical Plans | Dental Plans | |||||||||
| Blue Cross State Preferred |
Blue Cross Out of Area |
State BlueCare Point of Enrollment |
State BlueCare Point of Service |
M.D. Health Plan |
Kaiser Foundation |
Blue Cross Indemnity A & C |
Blue Cross Indemnity A, B & C |
CIGNA | ||
|---|---|---|---|---|---|---|---|---|---|---|
| Monthly | $241.04 | $241.04 | $197.41 | $219.34 | $185.19 | $179.28 | $19.18 | $24.28 | $14.71 | |
| State Portion | $203.34 | $227.04 | $197.41 | $205.34 | $185.19 | $179.28 | $19.18 | $19.18 | $14.71 | |
| Employee Portion | $37.70 | $14.00 | $0.00 | $14.00 | $0.00 | $0.00 | $0.00 | $5.10 | $0.00 | |
| Semi-Monthly | $120.52 | $120.52 | $98.71 | $109.67 | $92.60 | $89.64 | $9.59 | $12.14 | $7.36 | |
| Individual | State Portion | $101.67 | $113.52 | $98.71 | $102.67 | $92.60 | $89.64 | $9.59 | $9.59 | $7.36 |
| Employee Portion | $18.85 | $7.00 | $0.00 | $7.00 | $0.00 | $0.00 | $0.00 | $2.55 | $0.00 | |
| Bi-Weekly | $111.25 | $111.25 | $91.11 | $101.23 | $85.47 | $82.74 | $8.85 | $11.21 | $6.79 | |
| State Portion | $93.85 | $104.79 | $91.11 | $94.77 | $85.47 | $82.74 | $8.85 | $8.85 | $6.79 | |
| Employee Portion | $17.40 | $6.46 | $0.00 | $6.46 | $0.00 | $0.00 | $0.00 | $2.36 | $0.00 | |
| Monthly | $530.29 | $530.29 | $434.30 | $482.55 | $407.42 | $398.34 | $58.58 | $68.12 | $27.81 | |
| State Portion | $402.55 | $451.39 | $386.92 | $403.65 | $360.04 | $398.34 | $46.76 | $46.76 | $23.88 | |
| Employee Portion | $127.74 | $78.90 | $47.38 | $78.90 | $47.38 | $0.00 | $11.82 | $21.36 | $3.93 | |
| Semi-Monthly | $265.14 | $265.14 | $217.15 | $241.27 | $203.71 | $199.17 | $29.29 | $34.06 | $13.91 | |
| Subscriber | State Portion | $201.27 | $225.69 | $193.46 | $201.82 | $180.02 | $199.17 | $23.38 | $23.38 | $11.95 |
| plus 1 | Employee Portion | $63.87 | $39.45 | $23.69 | $39.45 | $23.69 | $0.00 | $5.91 | $10.68 | $1.96 |
| Bi-Weekly | $244.75 | $244.75 | $200.45 | $222.71 | $188.04 | $183.85 | $27.04 | $31.44 | $12.84 | |
| State Portion | $185.79 | $208.34 | $178.58 | $186.30 | $166.17 | $183.85 | $21.58 | $21.58 | $11.03 | |
| Employee Portion | $58.96 | $36.41 | $21.87 | $36.41 | $21.87 | $0.00 | $5.46 | $9.86 | $1.81 | |
| Monthly | $650.81 | $650.81 | $533.01 | $592.22 | $500.01 | $407.78 | $58.58 | $68.12 | $39.96 | |
| State Portion | $499.10 | $557.69 | $465.89 | $499.10 | $432.89 | $407.78 | $46.76 | $46.76 | $32.39 | |
| Employee Portion | $151.71 | $93.12 | $67.12 | $93.12 | $67.12 | $0.00 | $11.82 | $21.36 | $7.57 | |
| Semi-Monthly | $325.40 | $325.40 | $266.50 | $296.11 | $250.01 | $203.89 | $29.29 | $34.06 | $19.98 | |
| Family | State Portion | $249.55 | $278.84 | $232.94 | $249.55 | $216.45 | $203.89 | $23.38 | $23.38 | $16.19 |
| Employee Portion | $75.85 | $46.56 | $33.56 | $46.56 | $33.56 | $0.00 | $5.91 | $10.68 | $3.79 | |
| Bi-Weekly | $300.37 | $300.37 | $246.00 | $273.33 | $230.78 | $188.21 | $27.04 | $31.44 | $18.44 | |
| State Portion | $230.35 | $257.39 | $215.02 | $230.35 | $199.80 | $188.21 | $21.58 | $21.58 | $14.95 | |
| Employee Portion | $70.02 | $42.98 | $30.98 | $42.98 | $30.98 | $0.00 | $5.46 | $9.86 | $3.49 | |
| Monthly | $409.77 | $409.77 | $335.60 | $372.88 | $314.82 | $228.50 | $39.40 | $43.84 | $25.25 | |
| State Portion | $325.13 | $374.85 | $307.96 | $337.96 | $287.18 | $228.50 | $33.33 | $33.33 | $22.09 | |
| Employee Portion | $84.64 | $34.92 | $27.64 | $34.92 | $27.64 | $0.00 | $6.07 | $10.51 | $3.16 | |
| Semi-Monthly | $204.88 | $204.89 | $167.80 | $186.44 | $157.41 | $114.25 | $19.70 | $21.92 | $12.62 | |
| FLES | State Portion | $162.56 | $187.43 | $153.98 | $168.98 | $143.59 | $114.25 | $16.67 | $16.67 | $11.04 |
| Employee Portion | $42.32 | $17.46 | $13.82 | $17.46 | $13.82 | $0.00 | $3.03 | $5.25 | $1.58 | |
| Bi-Weekly | $189.12 | $189.12 | $154.89 | $172.10 | $145.30 | $105.46 | $18.19 | $20.23 | $11.65 | |
| State Portion | $150.06 | $173.00 | $142.13 | $155.98 | $132.54 | $105.46 | $15.39 | $15.39 | $10.19 | |
| Employee Portion | $39.06 | $16.12 | $12.76 | $16.12 | $12.76 | $0.00 | $2.80 | $4.84 | $1.46 | |
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