State of Connecticut

Attachment to:
 Comptroller's Memorandum 2001-29 
Rate Schedule
April 12, 2001

State Employee Health Insurance
7/1/2001 TO 6/30/2002 RATES
Bi-Weekly Rates Based on 26 Pay Periods
Medical Plans Dental Plans
Anthem Health Net ConnectiCare
Blue Cross State BlueCare   Blue Cross Indemnity
State Preferred Out of Area POS POE POE Plus Charter POS Charter HMO Passport HMO POS Open Access HMO Open Access HMO Personal Care Plan A & C A, B & C CIGNA
Monthly $391.61 $382.01 $275.27 $261.21 $249.45 $284.78 $276.84 $271.28 $268.61 $250.59 $224.81 $24.98 $31.62 $15.95
State Portion $331.03 $365.22 $258.48 $258.14 $249.45 $267.41 $272.83 $271.28 $252.22 $248.15 $224.81 $24.98 $24.98 $15.95
Employee Portion $60.58 $16.79 $16.79 $ 3.07 $ - $17.37 $ 4.01 $ - $16.39 $ 2.44 $ - $0.00 $6.64 $0.00
Semi-Monthly $195.81 $191.01 $137.64 $130.61 $124.73 $142.39 $138.42 $135.64 $134.31 $125.30 $112.41 $12.49 $15.81 $7.98
Individual State Portion $165.52 $182.61 $129.24 $129.07 $124.73 $133.70 $136.41 $135.64 $126.11 $124.08 $112.41 $12.49 $12.49 $7.98
Employee Portion $30.29 $8.40 $8.40 $1.54 $0.00 $8.69 $2.01 $0.00 $8.20 $1.22 $0.00 $0.00 $3.32 $0.00
Bi-Weekly $180.74 $176.31 $127.05 $120.56 $115.13 $131.44 $127.77 $125.21 $123.97 $115.66 $103.76 $11.53 $14.59 $7.36
State Portion $152.78 $168.56 $119.30 $119.14 $115.13 $123.42 $125.92 $125.21 $116.41 $114.53 $103.76 $11.53 $11.53 $7.36
Employee Portion $27.96 $7.75 $7.75 $1.42 $0.00 $8.02 $1.85 $0.00 $7.56 $1.13 $0.00 $0.00 $3.06 $0.00
Monthly $861.54 $840.42 $605.59 $574.66 $548.79 $626.52 $609.05 $596.82 $590.94 $551.30 $494.58 $76.31 $88.70 $35.10
State Portion $656.23 $745.77 $510.94 $516.91 $502.86 $528.60 $547.84 $546.87 $498.58 $495.89 $453.18 $60.91 $60.91 $29.35
Employee Portion $205.31 $94.65 $94.65 $57.75 $45.93 $97.92 $61.21 $49.95 $92.36 $55.41 $41.40 $15.40 $27.79 $5.75
Semi-Monthly $430.77 $420.21 $302.80 $287.33 $274.40 $313.26 $304.52 $298.41 $295.47 $275.65 $247.29 $38.15 $44.35 $17.55
Subscriber
plus 1
State Portion $328.11 $372.88 $255.47 $258.45 $251.43 $264.30 $273.91 $273.43 $249.29 $247.94 $226.59 $30.45 $30.45 $14.68
  Employee Portion $102.66 $47.33 $47.33 $28.88 $22.97 $48.96 $30.61 $24.98 $46.18 $27.71 $20.70 $7.70 $13.90 $2.87
Bi-Weekly $397.63 $387.89 $279.50 $265.23 $253.29 $289.16 $281.10 $275.45 $272.74 $254.45 $228.27 $35.22 $40.94 $16.20
State Portion $302.87 $344.21 $235.82 $238.58 $232.09 $243.97 $252.85 $252.40 $230.11 $228.88 $209.16 $28.11 $28.11 $13.55
Employee Portion $94.76 $43.68 $43.68 $26.65 $21.20 $45.19 $28.25 $23.05 $42.63 $25.57 $19.11 $7.11 $12.83 $2.65
Monthly $1,057.35 $1,031.43 $743.23 $705.27 $673.52 $768.91 $747.47 $732.46 $725.25 $676.59 $606.99 $76.31 $88.70 $43.07
State Portion $813.53 $919.72 $631.52 $623.46 $610.34 $653.34 $660.76 $663.76 $616.25 $598.11 $550.05 $60.91 $60.91 $34.94
Employee Portion $243.82 $111.71 $111.71 $81.81 $63.18 $115.57 $86.71 $68.70 $109.00 $78.48 $56.94 $15.40 $27.79 $8.13
Semi-Monthly $528.67 $515.71 $371.61 $352.63 $336.76 $384.45 $373.73 $366.23 $362.62 $338.30 $303.49 $38.15 $44.35 $21.54
Family State Portion $406.76 $459.85 $315.75 $311.72 $305.17 $326.66 $330.37 $331.88 $308.12 $299.06 $275.02 $30.45 $30.45 $17.47
Employee Portion $121.91 $55.86 $55.86 $40.91 $31.59 $57.79 $43.36 $34.35 $54.50 $39.24 $28.47 $7.70 $13.90 $4.07
Bi-Weekly $488.01 $476.04 $343.03 $325.51 $310.85 $354.88 $344.99 $338.06 $334.73 $312.27 $280.15 $35.22 $40.94 $19.88
State Portion $375.48 $424.48 $291.47 $287.75 $281.69 $301.54 $304.97 $306.35 $284.42 $276.05 $253.87 $28.11 $28.11 $16.12
Employee Portion $112.53 $51.56 $51.56 $37.76 $29.16 $53.34 $40.02 $31.71 $50.31 $36.22 $26.28 $7.11 $12.83 $3.76
Monthly $665.74 $649.42 $467.96 $444.06 $424.07 $484.13 $470.63 $461.18 $456.64 $426.00 $382.18 $51.33 $57.08 $27.12
State Portion $529.66 $607.49 $426.03 $410.36 $398.07 $440.75 $434.91 $432.91 $415.73 $393.67 $358.75 $43.42 $43.42 $23.77
Employee Portion $136.08 $41.93 $41.93 $33.70 $26.00 $43.38 $35.72 $28.27 $40.91 $32.33 $23.43 $7.91 $13.66 $3.35
Semi-Monthly $332.87 $324.71 $233.98 $222.03 $212.04 $242.07 $235.32 $230.59 $228.32 $213.00 $191.09 $25.66 $28.54 $13.56
FLES State Portion $264.83 $303.74 $213.01 $205.18 $199.04 $220.38 $217.46 $216.45 $207.86 $196.83 $179.37 $21.71 $21.71 $11.89
Employee Portion $68.04 $20.97 $20.97 $16.85 $13.00 $21.69 $17.86 $14.14 $20.46 $16.17 $11.72 $3.95 $6.83 $1.67
Bi-Weekly $307.26 $299.73 $215.98 $204.95 $195.72 $223.44 $217.21 $212.85 $210.76 $196.62 $176.39 $23.69 $26.35 $12.52
State Portion $244.45 $280.38 $196.63 $189.40 $183.72 $203.42 $200.72 $199.80 $191.88 $181.70 $165.58 $20.04 $20.04 $10.97
Employee Portion $62.81 $19.35 $19.35 $15.55 $12.00 $20.02 $16.49 $13.05 $18.88 $14.92 $10.81 $3.65 $6.31 $1.55

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