Full-Time Employees Earning < $62,100
Monthly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$0.00 |
$0.00 |
YOUR HSA-Eligible Plan |
$0.00 |
$0.00 |
Quarterly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$0.00 |
$0.00 |
YOUR HSA-Eligible Plan |
$0.00 |
$0.00 |
Full-Time Employees Earning $62,100 – $132,500 and Part-Time Employees < $132,500 with more than 5 Years of Service
Monthly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$61.14 |
$122.28 |
YOUR HSA-Eligible Plan |
$1.78 |
$3.56 |
Quarterly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$183.42 |
$366.84 |
YOUR HSA-Eligible Plan |
$5.34 |
$10.68 |
Part-Time Employees Earning < $132,500 with less than 5 Years of Service
Monthly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$112.56 |
$225.12 |
YOUR HSA-Eligible Plan |
$57.00 |
$114.00 |
Quarterly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$337.68 |
$675.36 |
YOUR HSA-Eligible Plan |
$171.00 |
$342.00 |
Employees Earning > $132,500
Monthly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$163.94 |
$327.88 |
YOUR HSA-Eligible Plan |
$111.90 |
$223.80 |
Quarterly Premium Contributions
University Health Care Plans |
Single |
Employee & Spouse/ Domestic Partner |
YOUR PPO Plan |
$491.82 |
$983.64 |
YOUR HSA-Eligible Plan |
$335.70 |
$671.40 |
Share of Dental Premiums
Monthly Premium Contributions
University Dental Plans**
|
Single |
Family |
Traditional Dental Plan |
$4.50 |
$9.16 |
Medallion Dental Plan |
$14.10 |
$28.88 |
Quarterly Premium Contributions
University Dental Plans**
|
Single |
Family |
Traditional Dental Plan |
$13.50 |
$27.48 |
Medallion Dental Plan |
$42.30 |
$86.64 |
* The rates above apply only to Faculty/Staff/SEIU members on Long-Term Disability who are Medicare-eligible and whose spouse or domestic partner are also Medicare-eligible. Medicare is the primary payer for health care expenses and the above plans through the University are the secondary payer. Therefore, the above University Health Care Plans will not cover any expenses that would have been covered under Medicare Part A and Part B if you were enrolled (commonly known as “carve out” plans).
** Eligibility rules apply