| Types of Plans |
Subscriber Only |
Subscriber Plus One |
Family |
Family Less Employed Spouse* |
| Point of Service Plans (POS) | ||||
|
$15.00 office visit co-pay - in-network/out-of-network benefits |
||||
| Anthem State Preferred POS | $47.32 | $160.37 | $190.46 | $106.30 |
| Anthem State BlueCare POS | $14.28 | $80.49 | $94.98 | $35.65 |
| Health Net Charter POS | $14.00 | $78.90 | $93.12 | $34.95 |
| Oxford Freedom Select POS | $12.66 | $71.35 | $84.20 |
$31.61 |
| Point of Enrollment Plans (POE) | ||||
| $10.00 office visit co-pay - in-network benefits only | ||||
| Anthem State BlueCare POE | $7.68 | $49.74 | $70.46 | $29.03 |
| Health Net Charter HMO | $7.19 | $47.90 | $67.86 | $27.96 |
| Oxford HMO Select POE | $6.06 | $43.75 | $61.98 | $25.54 |
| Point of Enrollment - Gatekeeper Plans (POE-G) | ||||
| $10.00 office visit co-pay - in-network benefits only - referrals required | ||||
| Anthem State BlueCare POE Plus | $5.38 | $40.80 | $56.11 | $23.09 |
| Health Net Passport HMO | $4.88 | $40.34 | $55.48 | $22.83 |
| Oxford HMO | $3.75 | $33.66 | $46.30 | $19.05 |
| Out of State - Out of Area Plans (OOA) | ||||
| $10.00 office visit co-pay | ||||
| Anthem State Preferred | $14.28 | $80.49 | $94.98 | $35.65 |
| Oxford USA | $12.66 | $71.35 | $84.20 | $31.61 |
* The Family Less Employed Spouse rate is available only when both spouses are employed by the State of Connecticut, eligible for health insurance, and enrolled in the same plan, along with at least one child. |
||||
| Subscriber
Only |
Subscriber
Plus One |
Family |
Family Less Employed Spouse |
|
| UnitedHealthCare Basic | $0.00 | $9.12 | $9.12 | $4.46 |
| UnitedHealthCare PPO - Enhanced Plan | $0.00 | $8.40 | $8.40 | $4.30 |
| Aetna DMO | $0.00 | $3.68 | $5.22 | $2.15 |