Health Premiums

Choose Your Appropriate Wellness $$ Level

Level Amount Requirements Completed
Full ($500/ee) Wellness $$ Additional $41.66/mo Biometric Screening, Health Assessment, Non-Tobacco User (completed affidavit)
Partial ($250) Wellness $$ Additional $20.83/mo Biometric Screening, Health Assessment, Tobacco Use (did not choose “reasonable alternative”)
No Wellness $$ No Additional $$ Did Not Take Biometric Screening/Health Assessment
Plan A ($750 Deductible, $2500 Out of Pocket Max ; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $755.81 $668.31 $87.50
Employee & Spouse $1,577.96 $932.82 $645.14
Employee & Children $1,349.76 $896.78 $452.98
Family $2,054.60 $1,033.99 $1,020.61
Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $626.65 $668.31 ($41.66)*
Employee & Spouse $1,308.31 $932.82 $375.49
Employee & Children $1,119.08 $896.78 $222.30
Family $1,703.51 $1,033.99 $669.52

* Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).

Plan C (H.S.A.) ($3,000 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $576.13 $668.31 ($92.18)*
Employee & Spouse $1,202.82 $932.82 $270.00
Employee & Children $1,028.87 $896.78 $132.09
Family $1,566.17 $1,033.99 $532.18

* Employee may use excess University Contributions for qualifying dental elections. If dental coverage is also employee only, excess contributions will cover Plan B (high option).

Per revised IRS regulations, excess University Contributions may no longer be added to H.S.A. account each month.

H.S.A Participants – The University will contribute $83.33/month to an H.S.A. account for employee only. And $166.67/month to an H.S.A. for those enrolled in dependent tiers.

Plan A ($750 Deductible, $2500 Out of Pocket Max ; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $755.81 $647.48 $108.33
Employee & Spouse $1,577.96 $911.99 $665.97
Employee & Children $1,349.76 $875.95 $473.81
Family $2,054.60 $1,013.16 $1,041.44
Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $626.65 $647.48 ($20.83)*
Employee & Spouse $1,308.31 $911.99 $396.32
Employee & Children $1,119.08 $875.95 $243.13
Family $1,703.51 $1,013.16 $690.35

* Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).

Plan C (H.S.A.) ($3,000 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $576.13 $647.48 ($71.35)*
Employee & Spouse $1,202.82 $911.99 $290.83
Employee & Children $1,028.87 $875.95 $152.92
Family $1,566.17 $1,013.16 $553.01

*Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).

Per revised IRS regulations, excess University Contributions may no longer be added to H.S.A. account each month.

H.S.A Participants – The University will contribute $83.33/month to an H.S.A. account for employee only. And $166.67/month to an H.S.A. for those enrolled in dependent tiers.

Plan A ($750 Deductible, $2500 Out of Pocket Max ; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $755.81 $626.65 $129.16
Employee & Spouse $1,577.96 $891.16 $686.80
Employee & Children $1,349.76 $855.12 $494.64
Family $2,054.60 $992.33 $1,062.27
Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $626.65 $626.65 $0
Employee & Spouse $1,308.31 $891.16 $417.15
Employee & Children $1,119.08 $855.12 $263.96
Family $1,703.51 $992.33 $711.18

 

Plan C (H.S.A.) ($3,000 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $576.13 $626.65 ($50.52)*
Employee & Spouse $1,202.82 $891.16 $311.66
Employee & Children $1,028.87 $855.12 $173.75
Family $1,566.17 $992.33 $573.84

*Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).

Per revised IRS regulations, excess University Contributions may no longer be added to H.S.A. account each month.

H.S.A Participants – The University will contribute $83.33/month to an H.S.A. account for employee only. And $166.67/month to an H.S.A. for those enrolled in dependent tiers.