Health Premiums for 9-Pay Faculty

Choose Your Appropriate Wellness $$ Level

Level Amount Requirements Completed
Full ($500/ee) Wellness $$ Additional $55.55/mo Biometric Screening, Health Assessment, Non-Tobacco User (completed affidavit)
Partial ($250) Wellness $$ Additional $27.77/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 $1,007.75 $891.08 $116.67
Employee & Spouse $2,103.95 $1,243.76 $860.19
Employee & Children $1,799.68 $1,195.71 $603.97
Family $2,739.47 $1,378.65 $1,360.82
Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $835.53 $891.08 ($55.55)*
Employee & Spouse $1,744.41 $1,243.76 $500.65
Employee & Children $1,492.11 $1,195.71 $296.40
Family $2,271.35 $1,378.65 $892.70

* 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 $768.17 $891.08 ($122.91)*
Employee & Spouse $1,603.76 $1,243.76 $360.00
Employee & Children $1,371.83 $1,195.71 $176.12
Family $2,088.23 $1,378.65 $709.58

* 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 $111.11/month to an H.S.A. account for employee only. And $222.22/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 $1,007.75 $863.31 $144.44
Employee & Spouse $2,103.95 $1,215.99 $887.96
Employee & Children $1,799.68 $1,167.93 $631.75
Family $2,739.47 $1,350.88 $1,388.59
Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $835.53 $863.31 ($27.78)*
Employee & Spouse $1,744.41 $1,215.99 $528.43
Employee & Children $1,492.11 $1,167.93 $324.17
Family $2,271.35 $1,350.88 $920.47

* 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 $768.17 $863.31 ($95.14)*
Employee & Spouse $1,603.76 $1,215.99 $387.77
Employee & Children $1,371.83 $1,167.93 $203.90
Family $2,088.23 $1,350.88 $737.35

* 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).

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 $111.11/month to an H.S.A. account for employee only. And $222.22/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 $1,007.75 $835.53 $172.22
Employee & Spouse $2,103.95 $1,188.21 $915.74
Employee & Children $1,799.68 $1,140.16 $659.52
Family $2,739.47 $1,323.11 $1,416.36
Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $835.53 $835.53 $0
Employee & Spouse $1,744.41 $1,188.21 $556.20
Employee & Children $1,492.11 $1,140.16 $351.95
Family $2,271.35 $1,323.11 $948.24

 

Plan C (H.S.A.) ($3,000 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage Total Premium University Contribution Employee Contribution
Employee Only $768.17 $835.53 ($67.36)*
Employee & Spouse $1,603.76 $1,188.21 $415.55
Employee & Children $1,371.83 $1,140.16 $231.67
Family $2,088.23 $1,323.11 $765.12

* 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 $111.11/month to an H.S.A. account for employee only. And $222.22/month to an H.S.A. for those enrolled in dependent tiers.