State of Connecticut

ATTACHMENT to:

Comptroller's Memorandum 2007-10

State Employee Health Insurance
7/1/2007 TO 6/30/2008 RATES
Monthly & Bi-Weekly Rates For Carrier Billing & Payment Purposes
Medical Plans Dental Plans
Anthem
Blue Cross State BlueCare Health Net Oxford Health United Health AETNA
State Preferred Out of Area POS POE POE
Plus
Charter POS Charter
 HMO
Passport HMO Freedom Select POS HMO
Select
HMO Oxford USA
Out of Area
Employ-
ees
Judges PPO DHMO
Individual Total Monthly Premium $662.79 $611.66 $507.14 $487.44 $480.05 $497.19 $469.42 $474.66 $449.56 $428.78 $396.13 $475.50 $32.15 $32.94 $29.57 $22.16
  Monthly State Share $560.26 $580.72 $476.20 $470.79 $468.40 $466.86 $453.85 $464.09 $422.14 $415.65 $388.00 $448.08 $32.15 $32.15 $29.57 $22.16
  Monthly Employee Share $102.53 $30.94 $30.94 $16.65 $11.65 $30.33 $15.57 $10.57 $27.42 $13.13 $8.13 $27.42 $0.00 $0.79 $0.00 $0.00
  Medical Premium $541.56 $490.43 $385.91 $366.21 $358.82 $375.96 $348.19 $353.43 $328.33 $307.55 $274.90 $354.27        
  Monthly Rx Drug $121.23 $121.23 $121.23 $121.23 $121.23 $121.23 $121.23 $121.23 $121.23 $121.23 $121.23 $121.23        
                                   
  BW State Share Rx Drug $55.95 $55.95 $55.95 $55.95 $55.95 $55.95 $55.95 $55.95 $55.95 $55.95 $55.95 $55.95        
  BW State Share Medical $258.58 $268.02 $219.78 $217.29 $216.18 $215.47 $209.47 $214.20 $194.83 $191.84 $179.08 $206.81 $14.84 $14.84 $13.65 $10.23
  BW Employee Share $47.32 $14.28 $14.28 $7.68 $5.38 $14.00 $7.19 $4.88 $12.66 $6.06 $3.75 $12.66 $0.00 $0.36 $0.00 $0.00
                                   
Subscriber Total Monthly Premium $1,458.14 $1,345.65 $1,115.71 $1,072.37 $1,056.11 $1,093.82 $1,032.72 $1,044.25 $989.03 $943.32 $871.49 $1,046.10 $98.05 $100.06 $90.19 $48.75
+ 1 Monthly State Share $1,110.67 $1,171.26 $941.32 $964.60 $967.71 $922.86 $928.93 $956.85 $834.44 $848.52 $798.55 $891.51 $78.28 $78.28 $72.00 $40.77
  Monthly Employee Share $347.47 $174.39 $174.39 $107.77 $88.40 $170.96 $103.79 $87.40 $154.59 $94.80 $72.94 $154.59 $19.77 $21.78 $18.19 $7.98
  Medical Premium $1,191.43 $1,078.95 $849.00 $805.66 $789.40 $827.11 $766.02 $777.55 $722.33 $676.61 $604.78 $779.39        
  Monthly Rx Drug $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71        
                                   
  BW State Share Rx Drug $123.10 $123.10 $123.10 $123.10 $123.10 $123.10 $123.10 $123.10 $123.10 $123.10 $123.10 $123.10        
  BW State Share Medical $512.62 $540.58 $434.46 $445.20 $446.64 $425.94 $428.74 $441.62 $385.13 $391.62 $368.56 $411.47 $36.13 $36.13 $33.23 $18.82
  BW Employee Share $160.37 $80.49 $80.49 $49.74 $40.80 $78.90 $47.90 $40.34 $71.35 $43.75 $33.66 $71.35 $9.12 $10.05 $8.40 $3.68
                                   
Family Total Monthly Premium $1,789.53 $1,651.48 $1,369.28 $1,316.09 $1,296.14 $1,342.41 $1,267.43 $1,281.58 $1,213.81 $1,157.71 $1,069.55 $1,283.85 $98.05 $100.06 $90.19 $59.83
  Monthly State Share $1,376.86 $1,445.68 $1,163.48 $1,163.42 $1,174.56 $1,140.65 $1,120.41 $1,161.37 $1,031.37 $1,023.42 $969.23 $1,101.41 $78.28 $78.28 $72.00 $48.53
  Monthly Employee Share $412.67 $205.80 $205.80 $152.67 $121.58 $201.76 $147.02 $120.21 $182.44 $134.29 $100.32 $182.44 $19.77 $21.78 $18.19 $11.30
  Medical Premium $1,462.21 $1,324.16 $1,041.96 $988.77 $968.81 $1,015.09 $940.11 $954.26 $886.49 $830.39 $742.23 $956.53        
  Monthly Rx Drug $327.32 $327.32 $327.32 $327.32 $327.32 $327.32 $327.32 $327.32 $327.32 $327.32 $327.32 $327.32        
                                   
  BW State Share Rx Drug $151.07 $151.07 $151.07 $151.07 $151.07 $151.07 $151.07 $151.07 $151.07 $151.07 $151.07 $151.07        
  BW State Share Medical $635.47 $667.24 $536.99 $536.96 $542.10 $526.45 $517.11 $536.02 $476.02 $472.35 $447.34 $508.34 $36.13 $36.13 $33.23 $22.40
  BW Employee Share $190.46 $94.98 $94.98 $70.46 $56.11 $93.12 $67.86 $55.48 $84.20 $61.98 $46.30 $84.20 $9.12 $10.05 $8.40 $5.22
                                   
                                   
FLES Total Monthly Premium $1,126.74 $1,039.82 $862.14 $828.65 $816.09 $845.22 $798.01 $806.92 $764.25 $728.93 $673.42 $808.35 $65.90 $67.12 $60.62 $37.67
  Monthly State Share $896.43 $962.57 $784.89 $765.76 $766.06 $769.49 $737.44 $757.46 $695.77 $673.60 $632.14 $739.87 $55.78 $55.78 $51.31 $33.02
  Monthly Employee Share $230.31 $77.25 $77.25 $62.89 $50.03 $75.73 $60.57 $49.46 $68.48 $55.33 $41.28 $68.48 $10.12 $11.34 $9.31 $4.65
  Medical Premium $920.65 $833.73 $656.05 $622.56 $609.99 $639.13 $591.92 $600.83 $558.16 $522.84 $467.33 $602.26        
  Monthly Rx Drug $206.09 $206.09 $206.09 $206.09 $206.09 $206.09 $206.09 $206.09 $206.09 $206.09 $206.09 $206.09        
                                   
  BW State Share Rx Drug $95.12 $95.12 $95.12 $95.12 $95.12 $95.12 $95.12 $95.12 $95.12 $95.12 $95.12 $95.12        
  BW State Share Medical $413.74 $444.26 $362.26 $353.43 $353.57 $355.15 $340.36 $349.60 $321.12 $310.89 $291.76 $341.48 $25.74 $25.74 $23.68 $15.24
  BW Employee Share $106.30 $35.65 $35.65 $29.03 $23.09 $34.95 $27.96 $22.83 $31.61 $25.54 $19.05 $31.61 $4.67 $5.23 $4.30 $2.15

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