State of Connecticut

Attachment to MEMORANDUM NO. 2003-19

State Employee Health Insurance
7/1/2003 TO 6/30/2004 RATES
Bi-Weekly Rates Based on 26 Pay Periods- NOT FOR MSA PAYROLL USE
Medical Plans Including Rx Drug
Anthem
Blue Cross State BlueCare Health Net ConnectiCare
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
Monthly $513.99 $501.39 $361.29 $342.85 $327.41 $341.77 $332.24 $325.57 $327.33 $305.37 $273.95
Individual State Portion $434.48 $479.35 $339.25 $334.88 $324.44 $320.92 $324.91 $323.24 $307.36 $299.65 $273.23
Employee Portion $79.51 $22.04 $22.04 $ 7.97 $ 2.97 $20.85 $ 7.33 $ 2.33 $19.97 $ 5.72 $ 0.72
Bi-Weekly $237.23 $231.41 $166.75 $158.24 $151.11 $157.74 $153.34 $150.26 $151.08 $140.94 $126.44
Individual State Portion $200.53 $221.24 $156.58 $154.56 $149.74 $148.12 $149.96 $149.18 $141.86 $138.30 $126.11
Employee Portion $36.70 $10.17 $10.17 $3.68 $1.37 $9.62 $3.38 $1.08 $9.22 $2.64 $0.33
Monthly $1,130.78 $1,103.06 $794.84 $754.27 $720.31 $751.89 $730.93 $716.25 $720.13 $671.81 $602.69
Subscriber+1 State Portion $861.32 $978.83 $670.61 $678.47 $660.02 $634.37 $657.47 $656.30 $607.57 $604.29 $552.24
Employee Portion $269.46 $124.23 $124.23 $75.80 $60.29 $117.52 $73.46 $59.95 $112.56 $67.52 $50.45
Bi-Weekly $521.90 $509.10 $366.85 $348.12 $332.45 $347.03 $337.35 $330.58 $332.37 $310.07 $278.16
Subscriber+1 State Portion $397.53 $451.76 $309.51 $313.14 $304.62 $292.79 $303.45 $302.91 $280.42 $278.91 $254.88
Employee Portion $124.37 $57.34 $57.34 $34.98 $27.83 $54.24 $33.90 $27.67 $51.95 $31.16 $23.28
Monthly $1,387.77 $1,353.75 $975.48 $925.70 $884.01 $922.78 $897.05 $879.04 $883.79 $824.50 $739.67
Family State Portion $1,067.75 $1,207.14 $828.87 $818.32 $801.09 $784.09 $792.99 $796.59 $750.96 $728.86 $670.29
Employee Portion $320.02 $146.61 $146.61 $107.38 $82.92 $138.69 $104.06 $82.45 $132.83 $95.64 $69.38
Bi-Weekly $640.51 $624.81 $450.22 $427.25 $408.00 $425.90 $414.02 $405.71 $407.90 $380.54 $341.39
Family State Portion $492.81 $557.14 $382.55 $377.69 $369.73 $361.89 $365.99 $367.66 $346.59 $336.40 $309.37
Employee Portion $147.70 $67.67 $67.67 $49.56 $38.27 $64.01 $48.03 $38.05 $61.31 $44.14 $32.02
Monthly $873.78 $852.36 $614.19 $582.85 $556.60 $581.01 $564.81 $553.47 $556.46 $519.13 $465.72
FLES State Portion $695.18 $797.33 $559.16 $538.61 $522.48 $528.95 $521.94 $519.54 $506.60 $479.73 $437.17
Employee Portion $178.60 $55.03 $55.03 $44.24 $34.12 $52.06 $42.87 $33.93 $49.86 $39.40 $28.55
Bi-Weekly $403.28 $393.40 $283.47 $269.01 $256.89 $268.16 $260.68 $255.45 $256.83 $239.60 $214.95
FLES State Portion $320.85 $368.00 $258.07 $248.59 $241.14 $244.13 $240.89 $239.79 $233.82 $221.42 $201.77
Employee Portion $82.43 $25.40 $25.40 $20.42 $15.75 $24.03 $19.79 $15.66 $23.01 $18.18 $13.18

 

Dental Plans
Blue Cross Indemnity
A & C A, B & C CIGNA
Monthly $27.91 $35.33 $18.48
Individual State Portion $27.91 $27.91 $18.48
Employee Portion $0.00 $7.42 $0.00
Bi-Weekly $12.88 $16.31 $8.53
Individual State Portion $12.88 $12.88 $8.53
Employee Portion $0.00 $3.43 $0.00
Monthly $85.26 $99.11 $40.66
Subscriber+1 State Portion $68.06 $68.06 $34.01
Employee Portion $17.20 $31.05 $6.65
Bi-Weekly $39.35 $45.74 $18.77
Subscriber+1 State Portion $31.41 $31.41 $15.70
Employee Portion $7.94 $14.33 $3.07
Monthly $85.26 $99.11 $49.90
Family State Portion $68.06 $68.06 $40.47
Employee Portion $17.20 $31.05 $9.43
Bi-Weekly $39.35 $45.74 $23.03
Family State Portion $31.41 $31.41 $18.68
Employee Portion $7.94 $14.33 $4.35
Monthly $57.35 $63.78 $31.42
FLES State Portion $48.52 $48.52 $27.54
Employee Portion $8.83 $15.26 $3.88
Bi-Weekly $26.47 $29.43 $14.50
FLES State Portion $22.39 $22.39 $12.71
Employee Portion $4.08 $7.04 $1.79

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