| Total Monthly Premium | Monthly Medical Premium | Monthly State Share Rx Drug | Monthly Medical State Share | Monthly Employee Share | BW State Share Rx Drug | BW State Share Medical | BW Employee Share | |||
|---|---|---|---|---|---|---|---|---|---|---|
| Anthem | Point of Enrollment - Gatekeeper (POE-G) | Employee Only | $581.79 | $463.69 | $118.10 | $415.81 | $47.88 | $54.51 | $191.91 | $22.10 |
| Employee +1 | $1,279.94 | $1,020.12 | $259.82 | $880.73 | $139.39 | $119.92 | $406.49 | $64.33 | ||
| Family | $1,570.83 | $1,251.96 | $318.87 | $1,072.26 | $179.70 | $147.17 | $494.89 | $82.94 | ||
| FLES | $989.04 | $788.27 | $200.77 | $695.30 | $92.97 | $92.66 | $320.91 | $42.91 | ||
| Point of Enrollment (POE) | Employee Only | $584.11 | $466.01 | $118.10 | $412.62 | $53.39 | $54.51 | $190.44 | $24.64 | |
| Employee +1 | $1,285.04 | $1,025.22 | $259.82 | $863.82 | $161.40 | $119.92 | $398.69 | $74.49 | ||
| Family | $1,577.10 | $1,258.23 | $318.87 | $1,042.96 | $215.27 | $147.17 | $481.37 | $99.36 | ||
| FLES | $992.99 | $792.22 | $200.77 | $684.58 | $107.64 | $92.66 | $315.96 | $49.68 | ||
| Point of Service (POS) | Employee Only | $603.54 | $485.44 | $118.10 | $416.27 | $69.17 | $54.51 | $192.12 | $31.92 | |
| Employee +1 | $1,327.79 | $1,067.97 | $259.82 | $828.17 | $239.80 | $119.92 | $382.23 | $110.68 | ||
| Family | $1,629.56 | $1,310.69 | $318.87 | $1,033.50 | $277.19 | $147.17 | $477.00 | $127.93 | ||
| FLES | $1,026.02 | $825.25 | $200.77 | $701.00 | $124.25 | $92.66 | $323.54 | $57.35 | ||
| Anthem Out of Area (OOA) | Employee Only | $827.37 | $709.27 | $118.10 | $640.10 | $69.17 | $54.51 | $295.43 | $31.92 | |
| Employee +1 | $1,820.21 | $1,560.39 | $259.82 | $1,320.59 | $239.80 | $119.92 | $609.50 | $110.68 | ||
| Family | $2,233.90 | $1,915.03 | $318.87 | $1,637.84 | $277.19 | $147.17 | $755.93 | $127.93 | ||
| FLES | $1,406.53 | $1,205.76 | $200.77 | $1,081.51 | $124.25 | $92.66 | $499.16 | $57.35 | ||
| Preferred | Employee Only | $864.70 | $746.60 | $118.10 | $580.23 | $166.37 | $54.51 | $267.80 | $76.79 | |
| Employee +1 | $1,902.34 | $1,642.52 | $259.82 | $1,156.66 | $485.86 | $119.92 | $533.84 | $224.24 | ||
| Family | $2,334.69 | $2,015.82 | $318.87 | $1,444.75 | $571.07 | $147.17 | $666.81 | $263.57 | ||
| FLES | $1,469.99 | $1,269.22 | $200.77 | $936.12 | $333.10 | $92.66 | $432.06 | $153.74 | ||
| Oxford | HMO (POE-G) | Employee Only | $443.33 | $325.23 | $118.10 | $283.96 | $41.27 | $54.51 | $131.06 | $19.05 |
| Employee +1 | $975.33 | $715.51 | $259.82 | $602.57 | $112.94 | $119.92 | $278.11 | $52.13 | ||
| Family | $1,196.99 | $878.12 | $318.87 | $734.48 | $143.64 | $147.17 | $338.99 | $66.30 | ||
| FLES | $753.66 | $552.89 | $200.77 | $475.34 | $77.55 | $92.66 | $219.39 | $35.79 | ||
| HMO Select (POE) | Employee Only | $481.97 | $363.87 | $118.10 | $317.12 | $46.75 | $54.51 | $146.36 | $21.58 | |
| Employee +1 | $1,060.33 | $800.51 | $259.82 | $662.56 | $137.95 | $119.92 | $305.80 | $63.67 | ||
| Family | $1,301.32 | $982.45 | $318.87 | $800.14 | $182.31 | $147.17 | $369.30 | $84.14 | ||
| FLES | $819.35 | $618.58 | $200.77 | $525.01 | $93.57 | $92.66 | $242.31 | $43.19 | ||
| Freedom Select POS (POS) | Employee Only | $506.53 | $388.43 | $118.10 | $326.08 | $62.35 | $54.51 | $150.50 | $28.78 | |
| Employee +1 | $1,114.37 | $854.55 | $259.82 | $648.95 | $205.60 | $119.92 | $299.52 | $94.89 | ||
| Family | $1,367.63 | $1,048.76 | $318.87 | $811.75 | $237.01 | $147.17 | $374.65 | $109.39 | ||
| FLES | $861.10 | $660.33 | $200.77 | $551.75 | $108.58 | $92.66 | $254.65 | $50.11 | ||
| Oxford Out of Area (OOA) | Employee Only | $537.23 | $419.13 | $118.10 | $356.78 | $62.35 | $54.51 | $164.67 | $28.78 | |
| Employee +1 | $1,181.91 | $922.09 | $259.82 | $716.49 | $205.60 | $119.92 | $330.69 | $94.89 | ||
| Family | $1,450.52 | $1,131.65 | $318.87 | $894.64 | $237.01 | $147.17 | $412.91 | $109.39 | ||
| FLES | $913.29 | $712.52 | $200.77 | $603.94 | $108.58 | $92.66 | $278.74 | $50.11 | ||
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