State of Connecticut

Attachment to:
COMPTROLLER'S MEMORANDUM NO. 2001-31
May 4, 2001

MSA TABLES 100% EMPLOYEE SHARE
Bi-Weekly Rates
SORT TABLE EMPLOYEE
CODE NO DEDUCTION
CHART AA Blue Cross Preferred POS 00001 D/OEs= PRE-TAX 7K, POST-TAX 7I
INDIVIDUAL 561 180.74
SUB+1 581 397.63
FAMILY 562 488.01
CHART BB BlueCare Point of Enrollment 00079 D/OEs= PRE-TAX 6S, POST-TAX 6Q
INDIVIDUAL 590 120.56
SUB+1 591 265.23
FAMILY 592 325.51
CHART CC BlueCare Point of Service 00077 D/OEs= PRE-TAX 7V, POST-TAX 7T
INDIVIDUAL 572 127.05
SUB+1 573 279.50
FAMILY 574 343.03
CHART DD ConnectiCare HMO Personal Care 00006 D/OEs= PRE-TAX 6M, POST-TAX 6K
INDIVIDUAL 569 103.76
SUB+1 570 228.27
FAMILY 571 280.15
CHART EE Health Net Charter HMO 00259 D/OEs= PRE-TAX 6X, POST-TAX 6V
INDIVIDUAL 593 127.77
SUB+1 594 281.10
FAMILY 595 344.99
CHART FF Blue Cross Dental A&C 00159 D/OEs= PRE-TAX 5X, POST-TAX 49
INDIVIDUAL 598 11.53
FAMILY 599 35.22
CHART GG CIGNA Dental 00185 D/OEs= PRE-TAX 5Y, POST-TAX 52
INDIVIDUAL 734 7.36
SUB+1 735 16.20
FAMILY 736 19.88
CHART HH Blue Cross Out of Area 00001 D/OEs= PRE-TAX 7Q, POST-TAX 7N
INDIVIDUAL 249 176.31
SUB+1 582 387.89
FAMILY 250 476.04
CHART II BlueCare POE Plus 00078 D/OEs= PRE-TAX 5D, POST-TAX 5E
INDIVIDUAL 300 115.13
SUB+1 301 253.29
FAMILY 302 310.85
       
CHART JJ Health Net Charter POS 00261 D/OEs= PRE-TAX 5M, POST-TAX 5N
INDIVIDUAL 362 131.44
SUB+1 363 289.16
FAMILY 364 354.88
CHART KK HealthNet Passport HMO 00260 D/OEs= PRE-TAX 5U, POST-TAX 5V
INDIVIDUAL 413 125.21
SUB+1 414 275.45
FAMILY 415 338.06
CHART LL CTCARE POS Open Access 00052 D/OEs= PRE-TAX 8P, POST-TAX 8M
INDIVIDUAL 478 123.97
SUB+1 479 272.74
FAMILY 480 334.73
CHART MM CTCARE HMO Open Access 00054 D/OEs= PRE-TAX 8U, POST-TAX 8S
INDIVIDUAL 481 115.66
SUB+1 482 254.45
FAMILY 483 312.27

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