Health Premiums for 9-Pay Faculty

Choose Your Appropriate Wellness $$ Level

Level		Requirements Completed
Full Wellness Credit ($500 to $550/yr)		Biometric Screening, Health Assessment, Non-Tobacco User (completed affidavit)
Partial Wellness Credit ($250 to $275/yr)		Biometric Screening, Health Assessment, Tobacco Use (did not choose “reasonable alternative”)
No Wellness Credit		Did Not Take Biometric Screening/Health Assessment

Plan A ($750 Deductible, $2,500 Out of Pocket Max ; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,245.48	$1,033.19	$212.29
Employee & Spouse	$2,600.28	$1,442.13	$1,158.15
Employee & Children	$2,224.24	$1,386.40	$837.84
Family	$3,385.73	$1,598.53	$1,787.20

Plan B ($1,500 Deductible , $5,000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$968.79	$1,024.34	($55.55)*
Employee & Spouse	$2,022.63	$1,442.13	$580.49
Employee & Children	$1,730.08	$1,386.40	$343.68
Family	$2,633.60	$1,598.53	$1,035.07

* 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/$3,400 Deductible, $5,000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$877.19	$1,000.10	($122.91)*
Employee & Spouse	$1,831.37	$1,436.09	$395.28
Employee & Children	$1,566.52	$1,373.13	$193.39
Family	$2,384.59	$1,598.54	$786.05

* 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).

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, $2,500 Out of Pocket Max ; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,245.48	$1,000.99	$244.49
Employee & Spouse	$2,600.28	$1,409.93	$1,190.35
Employee & Children	$2,224.24	$1,354.20	$870.04
Family	$3,385.73	$1,566.33	$1,819.40

Plan B ($1,500 Deductible , $5,000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$968.79	$996.56	($27.77)*
Employee & Spouse	$2,022.63	$1,409.93	$612.69
Employee & Children	$1,730.08	$1,354.20	$375.88
Family	$2,633.60	$1,566.33	$1,067.27

* 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/$3,400 Deductible, $5,000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$877.19	$972.32	($95.13)*
Employee & Spouse	$1,831.37	$1,405.60	$425.77
Employee & Children	$1,566.52	$1,342.64	$223.88
Family	$2,384.59	$1,566.34	$818.25

* 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).

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, $2,500 Out of Pocket Max ; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,245.48	$968.79	$276.69
Employee & Spouse	$2,600.28	$1,377.72	$1,222.56
Employee & Children	$2,224.24	$1,322.00	$902.24
Family	$3,385.73	$1,534.13	$1,851.60

Plan B ($1,500 Deductible , $5,000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$968.79	$968.79	$0
Employee & Spouse	$2,022.63	$1,377.72	$644.91
Employee & Children	$1,730.08	$1,322.00	$408.08
Family	$2,633.60	$1,534.13	$1,099.47

Plan C (H.S.A.) ($3,000/$3,400 Deductible, $5,000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$877.19	$944.55	($67.36)*
Employee & Spouse	$1,831.37	$1,375.09	$456.28
Employee & Children	$1,566.52	$1,312.15	$254.37
Family	$2,384.59	$1,534.14	$850.45

* 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).

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.