Health Premiums for 9-Pay Faculty

Choose Your Appropriate Wellness $$ Level

Level	Amount	Requirements Completed
Full Wellness $$	Appox. $550/yr	Biometric Screening, Health Assessment, Non-Tobacco User (completed affidavit)
Partial Wellness $$	Appox. $275/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 ($1,000 Deductible, $3,000 Out of Pocket Max ; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,457.59	$1,209.15	$248.44
Employee & Spouse	$3,043.12	$1,687.73	$1,355.39
Employee & Children	$2,603.04	$1,622.51	$980.53
Family	$3,962.35	$1,870.77	$2,091.58

Plan B ($1,750 Deductible , $5,000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,133.77	$1,189.32	($55.55)*
Employee & Spouse	$2,367.09	$1,687.73	$679.36
Employee & Children	$2,024.72	$1,622.51	$402.21
Family	$3,082.12	$1,870.77	$1,211.35

* 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/$3,500 Deductible, $5,000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,026.57	$1,149.48	($122.91)*
Employee & Spouse	$2,143.27	$1,680.67	$462.60
Employee & Children	$1,833.31	$1,606.99	$226.32
Family	$2,790.69	$1,870.77	$919.92

* 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 ($1,000 Deductible, $3,000 Out of Pocket Max ; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,457.59	$1,178.59	$279.00
Employee & Spouse	$3,043.12	$1,657.17	$1,385.95
Employee & Children	$2,603.04	$1,591.95	$1,011.09
Family	$3,962.35	$1,840.21	$2,122.14

Plan B ($1,750 Deductible , $5,000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,133.77	$1,158.76	($24.99)*
Employee & Spouse	$2,367.09	$1,657.17	$709.92
Employee & Children	$2,024.72	$1,591.95	$432.77
Family	$3,082.12	$1,840.21	$1,241.91

* 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/$3,500 Deductible, $5,000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,026.57	$1,118.92	($92.35)*
Employee & Spouse	$2,143.27	$1,650.11	$493.16
Employee & Children	$1,833.31	$1,576.43	$256.88
Family	$2,790.69	$1,840.21	$950.48

* 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 ($1,000 Deductible, $3,000 Out of Pocket Max ; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,457.59	$1,148.04	$309.55
Employee & Spouse	$3,043.12	$1,626.63	$1,416.49
Employee & Children	$2,603.04	$1,561.40	$1,041.64
Family	$3,962.35	$1,809.67	$2,152.68

Plan B ($1,750 Deductible , $5,000 Out of Pocket Max; 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,133.77	$1,128.21	$5.56
Employee & Spouse	$2,367.09	$1,626.63	$740.47
Employee & Children	$2,024.72	$1,561.40	$463.32
Family	$3,082.12	$1,809.67	$1,272.45

Plan C (H.S.A.) ($3,000/$3,500 Deductible, $5,000 Out of Pocket Max: 2x Family)
Coverage	Total Premium	University Contribution	Employee Contribution
Employee Only	$1,026.57	$1,088.37	($61.80)*
Employee & Spouse	$2,143.27	$1,619.56	$523.71
Employee & Children	$1,833.31	$1,545.88	$287.43
Family	$2,790.69	$1,809.67	$981.03

* 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.