Medical Plan

Individual

Subscriber &
1 Dependent

Family

State Preferred POS

$327.59

$720.20

$884.50

$313.91

$690.60

$847.56

State BlueCare POS

$231.88

$510.13

$626.07

State BlueCare POE

$224.76

$494.46

$606.84

State BlueCare Plus POE-G

$223.91

$492.59

$604.55

Health Net Charter POS

$243.11

$534.83

$656.39

Health Net Charter HMO POE

$229.14

$504.10

$618.66

Health Net Passport HMO POE-G

$231.77

$509.90

$625.78

Oxford Freedom Select POS

$201.87

$444.10

$545.03

Oxford HMO Select POE

$192.51

$423.52

$519.77

Oxford HMO POE-G

$177.80

$391.16

$480.06

Oxford USA Out-of-Area

$213.55

$469.81

$576.58

$16.31

$49.74

$49.74

$15.00

$45.75

$45.75

$9.96

$21.91

$26.89