Medical Plan

Individual

Subscriber &
1 Dependent

Family

Blue Cross State Preferred

$789.63

$1,737.19

$2,132.01

Blue Cross Out-of-Area

$756.15

$1,663.52

$2,041.60

State BlueCare POS

$555.35

$1,221.77

$1,499.44

State BlueCare POE

$537.92

$1,183.42

$1,452.38

State BlueCare POE Plus

$535.84

$1,178.84

$1,446.76

Health Net Charter POS

$529.37

$1,164.61

$1,429.30

Health Net Charter HMO POE

$499.13

$1,098.08

$1,347.64

Health Net Passport HMO POE-G

$504.83

$1,110.62

$1,363.04

Oxford Freedom Select POS

$479.39

$1,054.66

$1,294.35

Oxford HMO Select POE

$456.65

$1,004.64

$1,232.97

Oxford HMO POE-G

$420.89

$925.96

$1,136.41

Oxford USA Out-of-Area

$507.81

$1,117.18

$1,371.08

$38.16

$116.38

$116.38

$35.11

$107.08

$107.08

CIGNA Dental DHMO

$23.55

$51.82

$63.59