state of connecticut

MEMORANDUM NO. 97-22 Attachment 1

HEALTH INSURANCE RATES
MSA TABLES
Bi-Weekly Period End Date 6/5/97 Payable 6/20/97
Semi-Monthly Period End Date 6/30/97 Payable 6/30/97
Table
No
Employee
Deduction
Table
No
State
Portion
Chart A(PAIRED D/OEs 7J/7H PRE TAX) (SORT CODE 00001)
Blue Cross State Preferred (PAIRED D/OEs 7G/7H POST-TAX) (SORT CODE 00001)
26 Pay Bi-weekly
Individual01017.4001193.85
Subscriber + One01258.96013185.79
Family01470.02015230.35
FLES01839.06019150.06
24 Pay Semi-monthly
Individual21618.85217101.67
Subscriber + One21863.87219201.27
Family22075.85221249.55
FLES22442.32225162.56

Chart B(PAIRED D/OEs 5P/54 PRE-TAX) (SORT CODE 00159)
Blue Cross Dental w/A&C(PAIRED D/OEs 42/54 POST-TAX) (SORT CODE 00159)
26 Pay Bi-weekly
Individual1760.001778.85
Family1785.4617921.58
FLES1802.8018115.39
24 Pay Semi-monthly
Individual3820.003839.59
Family3845.9138523.38
FLES3863.0338716.67

Chart C(PAIRED D/OES 5P/54 PRE-TAX) (SORT CODE 00159)
Blue Cross Dental w/A,B,&C (PAIRED D/OES 42/54 POST-TAX) (SORT CODE 00159)
26 Pay Bi-weekly
Individual0422.360438.85
Family0449.8604521.58
FLES1744.8417515.39
24 Pay Semi-monthly
Individual2482.552469.59
Family24710.6825123.38
FLES3805.2538116.67

Chart D(PAIRED D/OEs 6R/6P PRE-TAX) (SORT CODE 00077)
BlueCare Point of Enrollment (PAIRED D/OEs 6N/6P POST-TAX) (SORT CODE 00077)
26 Pay Bi-weekly
Individual0460.0004791.11
Subscriber + One04821.87049178.58
Family05030.98051215.02
FLES05212.76053142.13
24 Pay Semi-monthly
Individual2520.0025398.71
Subscriber + One25423.69255193.46
Family25633.56257232.94
FLES25813.82259153.98

Chart E(PAIRED D/OEs 7U/7S PRE-TAX) (SORT CODE 00077)
BlueCare Point of Service (PAIRED D/OEs 7R/7S POST-TAX) (SORT CODE 00077)
26 Pay Bi-weekly
Individual0826.4608394.77
Subscriber + One08436.41085186.30
Family08642.98087230.35
FLES08816.12089155.98
24 Pay Semi-monthly
Individual2887.00289102.67
Subscriber + One29039.45291201.82
Family29246.56293249.55
FLES29417.46295168.98

Chart F(PAIRED D/OEs 6L/6J PRE-TAX) (SORT CODE 00006)
KaiserFoundation Health(PAIRED D/OEs 6I/6J POST-TAX) (SORT CODE 00006)
26 Pay Bi-weekly
Individual1260.0012782.74
Subscriber + One1280.00129183.85
Family1300.00131188.21
FLES1320.00133105.46
24 Pay Semi-monthly
Individual3320.0033389.64
Subscriber + One3340.00335199.17
Family3360.00337203.89
FLES3380.00339114.25

Chart G(PAIRED D/OEs 6W/6U PRE-TAX) (SORT CODE 00259)
M.D. Health Plan(PAIRED D/OEs 6T/6U POST-TAX) (SORT CODE 00259)
26 Pay Bi-weekly
Individual1160.0011785.47
Subscriber + One11821.87119166.17
Family12030.98121199.80
FLES12212.76123132.54
24 Pay Semi-monthly
Individual2600.0026192.60
Subscriber + One26223.69263180.02
Family26433.56265216.45
FLES27213.82273143.59

Chart H(PAIRED D/OEs 5R/5K PRE-TAX) (SORT CODE 00185)
CIGNA Dental Health(PAIRED D/OEs 5J/5K POST-TAX) (SORT CODE 00185)
26 Pay Bi-weekly
Individual1400.001416.79
Subscriber + One1421.8114311.03
Family1443.4914514.95
FLES1461.4614710.19
24 Pay Semi-monthly
Individual2760.002777.36
Subscriber + One2781.9627911.95
Family2803.7928116.19
FLES2821.5828311.04

Chart I(PAIRED D/OEs 7P/7M PRE-TAX) (SORT CODE 00001)
Blue Cross Out of Area Plan(PAIRED D/OEs 7L/7M POST-TAX) (SORT CODE 00001)
26 Pay Bi-weekly
Individual1346.46135104.79
Subscriber + One12436.41125208.34
Family13642.98137257.39
FLES13816.12139173.00
24 Pay Semi-monthly
Individual3447.00345113.52
Subscriber + One34039.45341225.69
Family34646.56347278.84
FLES34817.46349187.43

Paired DO/E's = Paired deductions employee/state share required to allow state contribution to the cost of coverage

Back to Comptroller's Home Page
Back to Index of Comptroller's Memoranda