COMPTROLLER'S SEAL STATE OF CONNECTICUT
STATE OF CONNECTICUT
NANCY WYMAN
COMPTROLLER
OFFICE OF THE STATE COMPTROLLER
55 ELM STREET
HARTFORD, CONNECTICUT 06106-1775
MARK OJAKIAN
DEPUTY COMPTROLLER

COMPTROLLER'S MEMORANDUM NO. 95 - 24

April 12, 1995

TO THE HEADS OF ALL STATE AGENCIES

ATTENTION: Personnel and Payroll Officers
SUBJECT:1995-96 Health Insurance Rates

AUTHORIZATION: In accordance with the provisions of Section 5-259 of the Connecticut General Statutes, the following premium changes have been approved for state-sponsored insurers.

PAYROLLS ON WHICH EFFECTIVE: The changes announced herein will be effective on the following payroll periods:

Bi-Weekly:May 26, 1995 - June 8, 1995
Payable June 23, 1995
Semi-Monthly:June 1-15, 1995
Payable June, 1995
Monthly: June 1995

CHARTS: Attached are revised rates for charts "A" through "I". Rate changes will be made centrally. Paired D/OEs for both pre and post-tax deductions are provided on all charts.

NOTICE TO EMPLOYEES: The 1995 Employees Health Care Planner, which is being mailed at the end of April, includes a schedule of all applicable bi-weekly payroll deductions. Employees on other than a bi-weekly pay plan should be notified of their appropriate rate changes.

QUESTIONS: Personnel or payroll staff who may have questions concerning payroll related procedures should call 566-5425. PLEASE DO NOT REFER EMPLOYEES DIRECTLY TO THIS NUMBER.

Nancy Wyman
State Comptroller

HEALTH INSURANCE RATES
MSA TABLES

Bi-Weekly Period End Date 6/8/95 Payable 6/23/95
Semi-Monthly Period End Date 6/15/95 Payable 6/15/95

Table
Number
Employee
Deduction
Table
Number
State
Portion
Chart A
Blue Cross (Paired D/OEs Pre-tax 7J/7H, Post-Tax 7G/7H)(Sort Code 00001)
POS Plan (State Preferred)
26 Pay Bi-Weekly
Individual 010 0.00 011 89.54
Family 014 42.98 015 189.82
FLES 018 16.12 019 127.14
24 Pay Semi-Monthly
Individual 216 0.00 217 97.00
Family 220 46.56 221 205.64
FLES 224 17.46 225 137.74
Chart B
BC Dental (Paired D/OEs Pre-tax 5P/54, Post-Tax 42/54)(Sort Code 00159)
With Riders A and C
26 Pay Bi-Weekly
Individual 176 0.00 177 7.72
Family 178 4.75 179 18.82
FLES 180 2.44 181 13.41
24 Pay Semi-Monthly
Individual 382 0.00 383 8.36
Family 384 5.15 385 20.38
FLES 386 2.64 387 14.53
Chart C
BC Dental (Paired D/OEs Pre-tax 5P/54, Post-Tax 42/54)(Sort Code 00159)
With Riders A,B, and C (Payroll CTBC only)
26 Pay Bi-Weekly
Individual 042 2.05 043 7.72
Family 044 8.58 045 18.82
FLES 174 4.22 175 13.41
24 Pay Semi-Monthly
Individual 248 2.22 246 8.36
Family 247 9.31 251 20.38
FLES 380 4.58 381 14.53
Chart D
BLUE CROSS (Paired D/OEs Pre-tax 6R/6P, Post-Tax 6N/6P)(Sort Code 00077)
POE Plan (Constitution Health Care)
26 Pay Bi-Weekly
Individual 046 0.00 047 85.51
Subscriber+One048 0.00 049 188.12
Family 050 41.05 051 189.82
FLES 052 18.22 053 127.14
24 Pay Semi-Monthly
Individual 252 0.00 253 92.64
Subscriber+One254 0.00 255 203.80
Family 256 44.47 257 205.64
FLES 258 19.73 259 137.74
Chart E
CHCP (Paired D/OEs Pre-tax 6G/6E, Post-Tax 6D/6E)(Sort Code 00004)
26 Pay Bi-Weekly
Individual 094 0.00 095 88.96
Subscriber+One096 20.56 097 189.82
Family 098 35.65 099 189.82
FLES 100 9.37 101 127.14
24 Pay Semi-Monthly
Individual 300 0.00 301 96.37
Subscriber+One302 22.27 303 205.64
Family 304 38.62 305 205.64
FLES 306 10.15 307 137.74
Chart F
KFHP (Paired D/OEs Pre-tax 6L/6J, Post-Tax 6I/6J)(Sort Code 00006)
26 Pay Bi-Weekly
Individual 126 0.00 127 80.87
Subscriber+One128 0.00 129 181.94
Family 130 4.26 131 189.82
FLES 132 0.00 133 113.21
24 Pay Semi-Monthly
Individual 332 0.00 333 87.61
Subscriber+One334 0.00 335 197.11
Family 336 4.61 337 205.64
FLES 338 0.00 339 122.64
Chart G
M.D.H.P. (Paired D/OEs Pre-tax 6W/6U, Post-Tax 6T/6U)(Sort Code 00259)
26 Pay Bi-Weekly
Individual 116 0.00 117 85.47
Subscriber+One118 0.00 119 188.04
Family 120 40.96 121 189.82
FLES 122 18.17 123 127.14
24 Pay Semi-Monthly
Individual 260 0.00 261 92.60
Subscriber+One262 0.00 263 203.71
Family 264 44.37 265 205.64
FLES 272 19.67 273 137.74
Chart H
CIGNA DENTAL (Paired D/OEs Pre-tax 5R/5K, Post-Tax 5J/5K)(Sort Code 00185)
26 Pay Bi-Weekly
Individual 140 0.00 141 6.29
Subscriber+One142 1.68 143 10.20
Family 144 3.24 145 13.84
FLES 146 1.35 147 9.44
24 Pay Semi-Monthly
Individual 276 0.00 277 6.81
Subscriber+One278 1.82 279 11.06
Family 280 3.51 281 14.99
FLES 282 1.46 283 10.23
Chart I
BLUE CROSS (Paired D/OEs Pre-tax 7P/7M, Post-Tax 7L/7M) (Sort Code 00001)
OUT-OF-AREA
26 Pay Bi-Weekly
Individual 134 0.00 135 106.07
Family 136 42.98 137 232.79
FLES 138 16.12 139 153.58
24 Pay Semi-Monthly
Individual 344 0.00 345 114.91
Family 346 46.56 347 252.19
FLES 348 17.46 349 166.38

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