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FY 2017-2018 GROUP INSURANCE BIWEEKLY …

Page 1 of 2 PLAN NAME/CODEO ptionEmployeeStateTotal[HAEX] State Health Plan PPOE mployee Only$ $ $ [HAEX] State Health Plan PPOE mployee & Spouse$ $ $ [HAEX] State Health Plan PPOE mployee & Child (ren)$ $ $ [HAEX] State Health Plan PPOFull Family$ $ $ NAME/CODEO ptionEmployeeStateTotalEmployee or Spouse w/Medicare (State pays 100%)Employee Only$ $ $ or Spouse w/Medicare (State pays 100%)Employee & Spouse$ $ $ or Spouse w/Medicare (State pays 100%)Employee & Child (ren)$ $ $ or Spouse w/Medicare (State pays 100%)Full Family$ $ $ NAME/CODEO ptionEmployeeStateTotal[H2F0] Catastrophic Health Plan 2 Employee Only$ $ $ [H2F0] Catastrophic Health Plan 2 Employee & Spouse$ $ $ [H2F0] Catastrophic Health Plan 2 Employee & Child (ren)$ $ $ [H2F0] Catastrophic Health Plan 2 Full Family$ $ $ NAME/CODEO ptionEmployeeStateTotal [HBCN] Blue Care NetworkEmployee Only$ $ $ [HBCN] Blue Care NetworkEmployee & Spouse$ $ $ [HBCN] Blue Care NetworkEmployee & Child (ren)$ $ $ [HBCN] Blue Care NetworkFull Family$ $ $ NAME/CODEO ptionEmployeeStateTotal [HI00] Health Alliance PlanEmployee Only$ $ $ [HI00] Health Alliance PlanEmployee & Spouse$ $ $ [HI00] Heal

Page 2 of 2 CIVIL SERVICE COMMISSION EMPLOYEE BENEFITS DIVISION FY 2017-2018 GROUP INSURANCE BIWEEKLY PREMIUM RATES EFFECTIVE OCTOBER 8, 2017 For NERE & Bargaining Units: AFSCME, MCO, MSEA, UAW, SEIU Local 517M, Judicial Branch, and Non-Represented (Z60-Z89)

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