Medical Plan

Individual

Subscriber &
1 Dependent

Family

State Preferred POS

$357.30

$786.06

$964.71

$342.15

$752.73

$923.81

State BlueCare POS

$251.29

$552.84

$678.49

State BlueCare POE

$243.40

$535.48

$657.19

State BlueCare Plus POE-G

$242.46

$533.41

$654.65

Health Net Charter POS

$239.54

$526.98

$646.75

Health Net Charter HMO POE

$225.85

$496.87

$609.80

Health Net Passport HMO POE-G

$228.43

$502.54

$616.76

Oxford Freedom Select POS

$216.92

$477.22

$585.69

Oxford HMO Select POE

$206.63

$454.59

$557.90

Oxford HMO POE-G

$190.45

$418.99

$514.21

Oxford USA Out-of-Area

$229.78

$505.51

$620.40

$17.27

$52.66

$52.66

$15.89

$48.45

$48.45

$10.66

$23.45

$28.77