Health Premiums for 9-Pay Faculty

Choose Your Appropriate Wellness $$ Level

Level	Amount	Requirements Completed
Full Wellness $$	Appox. $500/yr	Biometric Screening, Health Assessment, Non-Tobacco User (completed affidavit)
Partial Wellness $$	Appox. $250/yr	Biometric Screening, Health Assessment, Tobacco Use (did not choose “reasonable alternative”)
No Wellness $$	No $$ Credit	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	$1,161.83	$978.40	$183.43
Employee & Spouse	$2,425.64	$1,365.65	$1,059.99
Employee & Children	$2,074.85	$1,312.88	$761.97
Family	$3,158.33	$1,513.76	$1,644.57

Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$917.41	$972.96	($55.55)*
Employee & Spouse	$1,915.36	$1,365.65	$549.71
Employee & Children	$1,638.33	$1,312.88	$325.45
Family	$2,493.93	$1,513.76	$980.17

* 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.) ($3,300 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$843.45	$966.36	($122.91)*
Employee & Spouse	$1,760.93	$1,365.65	$395.28
Employee & Children	$1,506.27	$1,312.88	$193.39
Family	$2,292.87	$1,513.76	$779.11

* 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. 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	$1,161.83	$947.91	$213.92
Employee & Spouse	$2,425.64	$1,335.16	$1,090.48
Employee & Children	$2,074.85	$1,282.39	$792.46
Family	$3,158.33	$1,483.27	$1,675.06

Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$917.41	$945.19	($27.78)*
Employee & Spouse	$1,915.36	$1,335.16	$580.20
Employee & Children	$1,638.33	$1,282.39	$355.94
Family	$2,493.93	$1,483.27	$1,010.66

* 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.) ($3,300 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$843.45	$938.59	($95.14)*
Employee & Spouse	$1,760.93	$1,335.16	$425.77
Employee & Children	$1,506.27	$1,282.39	$223.88
Family	$2,292.87	$1,483.27	$809.60

* 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. 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	$1,161.83	$917.41	$244.42
Employee & Spouse	$2,425.64	$1,304.65	$1,120.99
Employee & Children	$2,074.85	$1,251.89	$822.96
Family	$3,158.33	$1,452.77	$1,705.56

Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$917.41	$917.41	$0
Employee & Spouse	$1,915.36	$1,304.65	$610.71
Employee & Children	$1,638.33	$1,251.89	$386.44
Family	$2,493.93	$1,452.77	$1,041.16

Plan C (H.S.A.) ($3,300 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$843.45	$910.81	($67.36)*
Employee & Spouse	$1,760.93	$1,304.65	$456.28
Employee & Children	$1,506.27	$1,251.89	$254.38
Family	$2,292.87	$1,452.77	$840.10

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