Health Premiums – 2025benefits

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	$871.37	$733.80	$137.57
Employee & Spouse	$1,819.23	$1,024.24	$794.99
Employee & Children	$1,556.14	$984.66	$571.48
Family	$2,368.75	$1,135.32	$1,233.43

Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$688.06	$729.72	($41.66)*
Employee & Spouse	$1,436.52	$1,024.24	$412.28
Employee & Children	$1,228.75	$984.66	$244.09
Family	$1,870.45	$1,135.32	$735.13

* 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	$632.59	$724.77	($92.18)*
Employee & Spouse	$1,320.70	$1,024.24	$296.46
Employee & Children	$1,129.70	$984.66	$145.04
Family	$1,719.65	$1,135.32	$584.33

* 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 $83.33/month to an H.S.A. 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	$871.37	$710.93	$160.44
Employee & Spouse	$1,819.23	$1,001.37	$817.86
Employee & Children	$1,556.14	$961.79	$594.35
Family	$2,368.75	$1,112.45	$1,256.30

Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$688.06	$708.89	($20.83)*
Employee & Spouse	$1,436.52	$1,001.37	$435.15
Employee & Children	$1,228.75	$961.79	$266.96
Family	$1,870.45	$1,112.45	$758.00

* 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	$632.59	$703.94	($71.35)*
Employee & Spouse	$1,320.70	$1,001.37	$319.33
Employee & Children	$1,129.70	$961.79	$167.91
Family	$1,719.65	$1,112.45	$607.20

*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 $83.33/month to an H.S.A. 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	$871.37	$688.06	$183.31
Employee & Spouse	$1,819.23	$978.49	$840.74
Employee & Children	$1,556.14	$938.92	$617.22
Family	$2,368.75	$1,089.58	$1,279.17

Plan B ($1,500 Deductible , $5000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$688.06	$688.06	$0
Employee & Spouse	$1,436.52	$978.49	$458.03
Employee & Children	$1,228.75	$938.92	$289.83
Family	$1,870.45	$1,089.58	$780.87

Plan C (H.S.A.) ($3,300 Deductible, $5000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$632.59	$683.11	($50.52)*
Employee & Spouse	$1,320.70	$978.49	$342.21
Employee & Children	$1,129.70	$938.92	$190.78
Family	$1,719.65	$1,089.58	$630.07

*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).

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