ATTACHMENT TO MEMORANDUM 2002-19
| MSA TABLES 100% EMPLOYEE SHARE | |||
| Bi-Weekly Rates | |||
| SORT CODE | TABLE NO |
EMPLOYEE DEDUCTION |
|
|---|---|---|---|
| CHART AA Blue Cross Preferred POS | 00001 | D/OEs = PRE-TAX 7K, POST-TAX 7I | |
| INDIVIDUAL | 561 | 206.95 | |
| SUB+1 | 581 | 455.29 | |
| FAMILY | 562 | 558.76 | |
| CHART BB BlueCare Point of Enrollment | 00079 | D/OEs = PRE-TAX 6S, POST-TAX 6Q | |
| INDIVIDUAL | 590 | 138.04 | |
| SUB+1 | 591 | 303.69 | |
| FAMILY | 592 | 372.71 | |
| CHART CC BlueCare Point of Service | 00077 | D/OEs = PRE-TAX 7V, POST-TAX 7T | |
| INDIVIDUAL | 572 | 145.47 | |
| SUB+1 | 573 | 320.03 | |
| FAMILY | 574 | 392.76 | |
| CHART DD ConnectiCare HMO Personal Care | 00006 | D/OEs = PRE-TAX 6M, POST-TAX 6K | |
| INDIVIDUAL | 569 | 113.56 | |
| SUB+1 | 570 | 249.84 | |
| FAMILY | 571 | 306.62 | |
| CHART EE Health Net Charter HMO | 00259 | D/OEs = PRE-TAX 6X, POST-TAX 6V | |
| INDIVIDUAL | 593 | 139.53 | |
| SUB+1 | 594 | 306.96 | |
| FAMILY | 595 | 376.73 | |
| CHART FF Blue Cross Dental A&C | 00159 | D/OEs = PRE-TAX 5X, POST-TAX 49 | |
| INDIVIDUAL | 598 | 11.76 | |
| FAMILY | 599 | 35.92 | |
| CHART GG CIGNA Dental | 00185 | D/OEs = PRE-TAX 5Y, POST-TAX 52 | |
| INDIVIDUAL | 734 | 7.66 | |
| SUB+1 | 735 | 16.85 | |
| FAMILY | 736 | 20.67 | |
| CHART HH Blue Cross Out of Area | 00001 | D/OEs = PRE-TAX 7Q, POST-TAX 7N | |
| INDIVIDUAL | 249 | 201.88 | |
| SUB+1 | 582 | 444.13 | |
| FAMILY | 250 | 545.07 | |
| CHART II BlueCare POE Plus | 00078 | D/OEs = PRE-TAX 5D, POST-TAX 5E | |
| INDIVIDUAL | 300 | 131.82 | |
| SUB+1 | 301 | 290.01 | |
| FAMILY | 302 | 355.92 | |
| CHART JJ Health Net Charter POS | 00261 | D/OEs = PRE-TAX 5M, POST-TAX 5N | |
| INDIVIDUAL | 362 | 143.53 | |
| SUB+1 | 363 | 315.77 | |
| FAMILY | 364 | 387.53 | |
| CHART KK Health Net Passport HMO | 00260 | D/OEs = PRE-TAX 5U, POST-TAX 5V | |
| INDIVIDUAL | 413 | 136.73 | |
| SUB+1 | 414 | 300.80 | |
| FAMILY | 415 | 369.16 | |
| CHART LL CTCARE POS Open Access | 00052 | D/OEs = PRE-TAX 8P, POST-TAX 8M | |
| INDIVIDUAL | 478 | 135.69 | |
| SUB+1 | 479 | 298.51 | |
| FAMILY | 480 | 366.36 | |
| CHART MM CTCARE HMO Open Access | 00054 | D/OEs = PRE-TAX 8U, POST-TAX 8S | |
| INDIVIDUAL | 481 | 126.59 | |
| SUB+1 | 482 | 278.49 | |
| FAMILY | 483 | 341.78 | |
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