State Employee Health Plan Non-Qualified Individual

Payroll Information - Bi-Weekly Charts

July 2008 - June 2009

If adding a Non-Qualified Same-Sex Spouse, Civil Union Partner, Same-Sex Domestic Partner, Child or Children to your plan will change your Option (Coverage Class), use Table I to find your current and new bi-weekly deduction amount. If you are currently paying the Family or FLES rate, there will be no change in your health insurance deduction amount. Any additional deduction will be subject to both federal and state taxes. The additional State cost to cover an individual who is not a dependent under 152 of the Internal Revenue Code is taxable income to the employee, and the employer is required to include the Fair Market Value for this benefit in the employees taxable wages. Table II indicates the per-individual Bi-Weekly and Annual State cost (Fair Market Value) that is subject to State and Federal tax withholding, and will be included on the employee's Form W-2. Since the Annual amount below is calculated on a fiscal year basis, the calendar year amount will be different.
Table I - Employee Bi-Weekly Deduction Table II - Health Insurance Fair Market Value 2008-09
Medical Plan Employee Empl.+1 Family Add 1 Individual Add 2 Individuals Add 3 or More Individuals
Anthem Annual Bi-Weekly Annual Bi-Weekly Annual Bi-Weekly
State Preferred $50.68 $171.74 $203.96 $7,199.76 $276.91 $14,272.92 $548.96 $17,693.88 $680.53
BlueCare POS $14.15 $79.74 $94.10 $5,661.00 $217.73 $11,190.24 $430.39 $13,831.20 $531.97
BlueCare POE $7.67 $49.69 $70.39 $5,644.20 $217.08 $11,563.92 $444.77 $13,947.60 $536.45
BlueCare POE Plus $5.36 $41.23 $56.70 $5,682.12 $218.54 $11,735.52 $451.37 $14,243.88 $547.84
Health Net
Charter POS $14.83 $83.59 $98.65 $5,935.20 $228.28 $11,732.28 $451.24 $14,501.04 $557.73
Charter HMO $7.93 $50.66 $71.76 $5,751.24 $221.20 $11,789.28 $453.43 $14,219.40 $546.90
Passport HMO $5.63 $42.68 $58.70 $5,879.76 $226.14 $12,147.60 $467.22 $14,744.16 $567.08
Oxford
Freedom Select POS $12.31 $69.41 $81.92 $4,928.28 $189.55 $9,741.84 $374.69 $12,040.92 $463.11
HMO Select POE $5.74 $42.56 $60.30 $4,856.04 $186.77 $9,904.80 $380.95 $11,946.36 $459.48
HMO $3.43 $32.74 $45.03 $4,533.60 $174.37 $9,318.84 $358.42 $11,310.72 $435.03
Dental Plan Employee Empl.+1 Family Add 1 Individual Add 2 Individuals Add 3 or More Individuals
UnitedHealthCare Annual Bi-Weekly Annual Bi-Weekly Annual Bi-Weekly
Basic - $10.03 $10.03 $424.06 $16.31 $1032.46 $39.71 $1032.46 $39.71
Judges $0.40 $11.09 $11.09 $424.06 $16.31 $1032.46 $39.71 $1032.46 $39.71
Enhanced - $9.23 $9.23 $390.00 $15.00 $949.78 $36.53 $949.78 $36.53
CIGNA Dental DHMO - $3.59 $5.08 $258.96 $9.96 $476.58 $18.33 $567.06 $21.81

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