Medical Plan

Individual

Subscriber &
1 Dependent

Family

Blue Cross State Preferred

$723.98

$1,592.75

$1,954.73

Blue Cross Out-of-Area

$693.74

$1,526.23

$1,873.11

State BlueCare POS

$512.45

$1,127.39

$1,383.61

State BlueCare POE

$496.71

$1,092.76

$1,341.12

State BlueCare POE Plus

$494.83

$1,088.63

$1,336.05

Health Net Charter POS

$537.26

$1,181.98

$1,450.61

Health Net Charter HMO POE

$506.39

$1,114.06

$1,367.25

Health Net Passport HMO POE-G

$512.21

$1,126.87

$1,382.98

Oxford Freedom Select POS

$446.12

$981.46

$1,204.52

Oxford HMO Select POE

$425.44

$935.97

$1,148.69

Oxford HMO POE-G

$392.93

$864.46

$1,060.92

Oxford USA Out-of-Area

$471.94

$1,038.28

$1,274.25

$36.04

$109.92

$109.92

$33.15

$101.11

$101.11

Aetna DMO

$22.01

$48.43

$48.43