State of Connecticut

Attachment to Memorandum 2005-13

State Employee Health Insurance
7/1/2005 TO 6/30/2006 Employee Share Rates Based on Final Premium Rates for Contributions
Bi-Weekly Rates Based on 26 Pay Periods
Medical Plans Including Rx Drug
Anthem
Blue Cross State
BlueCare
Health Net Oxford Health
State
Preferred
Out
of
Area
POS POE POE Plus Char-
ter
POS
Char-
ter HMO
Pass-
port
HMO
POS POE POE-G Out
of
Area
Indiv-
idual
Monthly Pre-
mium
$568.36 $524.18 $433.87 $416.85 $410.46 $442.06 $416.83 $421.59 $423.66 $403.20 $371.06 $449.19
Employee 
Share
$87.93 $26.47 $26.47 $ 12.41 $ 7.41 $26.97 $ 12.41 $ 7.41 $25.84 $ 11.59 $ 6.59 $ 25.84
Semi-
Monthly
Premium $284.18 $262.09 $216.94 $208.43 $205.23 $221.03 $208.42 $210.80 $211.83 $201.60 $185.53 $224.60
Employee 
Share
$43.97 $13.24 $13.24 $6.21 $3.71 $13.49 $6.21 $3.71 $12.92 $5.80 $3.30 $12.92
Bi-
Weekly
Premium $262.32 $241.93 $200.25 $192.39 $189.44 $204.03 $192.38 $194.58 $195.54 $186.09 $171.26 $207.32
Employee
Share
$40.58 $12.22 $12.22 $5.73 $3.42 $12.45 $5.73 $3.42 $11.93 $5.35 $3.04 $11.93
Subscrib-
er+1
Monthly Premium $1,250.39 $1,153.20 $954.51 $917.07 $903.02 $972.53 $917.03 $927.50 $932.05 $887.04 $816.33 $988.22
Employee 
Share
$297.97 $149.19 $149.19 $92.17 $75.58 $152.01 $92.16 $77.63 $145.68 $89.15 $68.33 $145.68
Semi-
Monthly
Premium $625.20 $576.60 $477.26 $458.54 $451.51 $486.27 $458.52 $463.75 $466.03 $443.52 $408.17 $494.11
Employee 
Share
$148.99 $74.60 $74.60 $46.09 $37.79 $76.01 $46.08 $38.82 $72.84 $44.58 $34.17 $72.84
Bi-
Weekly
Premium $577.10 $532.25 $440.54 $423.26 $416.78 $448.86 $423.24 $428.08 $430.18 $409.40 $376.77 $456.10
Employee 
Share
$137.52 $68.86 $68.86 $42.54 $34.88 $70.16 $42.54 $35.83 $67.24 $41.15 $31.54 $67.24
Family Monthly Premium $1,534.57 $1,415.29 $1,171.45 $1,125.50 $1,108.24 $1,193.56 $1,125.44 $1,138.29 $1,143.88 $1,088.64 $1,001.86 $1,212.81
Employee 
Share
$353.87 $176.07 $176.07 $130.56 $103.95 $179.39 $130.55 $106.77 $171.93 $126.28 $93.97 $171.93
Semi-
Monthly
Premium $767.29 $707.65 $585.73 $562.75 $554.12 $596.78 $562.72 $569.15 $571.94 $544.32 $500.93 $606.41
Employee 
Share
$176.94 $88.04 $88.04 $65.28 $51.98 $89.70 $65.28 $53.39 $85.97 $63.14 $46.99 $85.97
Bi-
Weekly
Premium $708.26 $653.21 $540.67 $519.46 $511.50 $550.87 $519.43 $525.36 $527.94 $502.45 $462.40 $559.76
Employee 
Share
$163.32 $81.26 $81.26 $60.26 $47.98 $82.80 $60.25 $49.28 $79.35 $58.28 $43.37 $79.35
FLES Monthly Premium $966.21 $891.11 $737.58 $708.65 $697.78 $751.50 $708.61 $716.70 $720.22 $685.44 $630.80 $763.62
Employee
Share
$197.49 $66.09 $66.09 $53.79 $42.77 $67.33 $53.78 $43.93 $64.53 $52.02 $38.67 $64.53
Semi-
Monthly
Premium $483.11 $445.56 $368.79 $354.33 $348.89 $375.75 $354.31 $358.35 $360.11 $342.72 $315.40 $381.81
Employee
Share
$98.75 $33.05 $33.05 $26.90 $21.39 $33.67 $26.89 $21.97 $32.27 $26.01 $19.34 $32.27
Bi-
Weekly
Premium $445.94 $411.28 $340.42 $327.07 $322.05 $346.85 $327.05 $330.78 $332.41 $316.36 $291.14 $352.44
Employee
Share
$91.15 $30.50 $30.50 $24.83 $19.74 $31.08 $24.82 $20.28 $29.78 $24.01 $17.85 $29.78

 

State Employee Health Insurance
7/1/2005 TO 6/30/2006 Employee Share Rates Based on Final Premium Rates for Contributions
Bi-Weekly Rates Based on 26 Pay Periods
Dental
United Dental Aetna DMO
Basic Judges PPO
Indiv-
idual
Monthly Premium $29.25 $29.97 $26.91 $18.50
Employee 
Share
$0.00 $0.72 $0.00 $0.00
Semi-
Monthly
Premium $14.63 $14.99 $13.46 $9.25
Employee 
Share
$0.00 $0.36 $0.00 $0.00
Bi-
Weekly
Premium $13.50 $12.42 $8.54
Employee
 Share
$0.00 $0.00 $0.00
Subscrib-
er+1
Monthly Premium $89.22 $91.05 $82.07 $40.70
Employee 
hare
$17.99 $19.82 $16.55 $6.66
Semi-
Monthly
Premium $44.61 $45.53 $41.04 $20.35
Employee 
Share
$8.99 $9.91 $8.27 $3.33
Bi-
Weekly
Premium $41.18 $37.88 $18.78
Employee 
Share
$8.30 $7.64 $3.07
Family Monthly Premium $89.22 $91.05 $82.07 $49.95
Employee 
Share
$17.99 $19.82 $16.55 $9.43
Semi-
Monthly
Premium $44.61 $45.53 $41.04 $24.98
Employee 
Share
$8.99 $9.91 $8.27 $4.72
Bi-
Weekly
Premium $41.18 $37.88 $23.05
Employee 
Share
$8.30 $7.64 $4.35
FLES Monthly Premium $59.97 $61.08 $55.16 $31.45
Employee
 Share
$9.22 $10.33 $8.47 $3.88
Semi-
Monthly
Premium $29.98 $30.54 $27.58 $15.73
Employee
 Share
$4.60 $5.16 $4.24 $1.94
Bi-
Weekly
Premium $27.68 $25.46 $14.51
Employee
Share
$4.25 $3.91 $1.79

 

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