Health care plan rates: Long-term disability
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Long-term disability rates
January 1–December 31, 2024
Share of Premiums for Faculty, Staff, and SEIU Members on Long-Term Disability who are Medicare-eligible and whose spouse or domestic partner are also Medicare-eligible*
Full-time employees earning < $68,900
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 $68,900 to < $102,300
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $65.00 | $130.00 |
| YOUR HSA-Eligible Plan | $3.14 | $6.28 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $195.00 | $390.00 |
| YOUR HSA-Eligible Plan | $9.42 | $18.84 |
Full-time employees earning $102,300 – $147,000 and part-time employees < $147,000 with more than 5 years of service
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $83.90 | $167.80 |
| YOUR HSA-Eligible Plan | $5.32 | $10.64 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $251.70 | $503.40 |
| YOUR HSA-Eligible Plan | $15.96 | $31.92 |
Part-time employees earning less than $147,000 with less than 5 years of service**
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $139.12 | $278.24 |
| YOUR HSA-Eligible Plan | $70.44 | $140.88 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $417.36 | $834.72 |
| YOUR HSA-Eligible Plan | $211.32 | $422.64 |
Employees earning $147,000 to <$184,600
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $154.58 | $309.16 |
| YOUR HSA-Eligible Plan | $49.80 | $99.60 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $463.74 | $927.48 |
| YOUR HSA-Eligible Plan | $149.40 | $298.80 |
Employees earning $184,600 to <$242,100
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $219.50 | $439.00 |
| YOUR HSA-Eligible Plan | $113.30 | $226.60 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $658.50 | $1,317.00 |
| YOUR HSA-Eligible Plan | $339.90 | $679.80 |
Employees earning > $242,100
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $275.08 | $550.16 |
| YOUR HSA-Eligible Plan | $152.90 | $305.80 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $825.24 | $1,650.48 |
| YOUR HSA-Eligible Plan | $458.70 | $917.40 |
Dental plans**
Monthly Rates
| University Dental Plans |
Single | Family |
| Traditional Dental Plan | $4.66 | $9.46 |
| Medallion Dental Plan | $14.56 | $29.82 |
Quarterly Rates
| University Dental Plans** |
Single | Family |
| Traditional Dental Plan | $13.98 | $28.38 |
| Medallion Dental Plan | $43.68 | $89.46 |
* 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
Share of Premiums for Faculty, Staff, and SEIU Members on Long-Term Disability and both Member and Spouse/Domestic Partner are NON-Medicare eligible*
Full-time employees earning < $68,900
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $135.48 | $436.28 | $319.96 | $243.76 |
| YOUR HSA-Eligible Plan | $13.86 | $44.58 | $32.70 | $24.90 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $406.44 | $1,308.84 | $959.88 | $731.28 |
| YOUR HSA-Eligible Plan | $41.58 | $133.74 | $98.10 | $74.70 |
Full-time employees earning $68,900 to <$102,300
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $200.48 | $645.72 | $473.56 | $360.86 |
| YOUR HSA-Eligible Plan | $17.00 | $54.76 | $40.16 | $30.56 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $601.44 | $1,937.16 | $1,420.68 | $1,082.58 |
| YOUR HSA-Eligible Plan | $51.00 | $164.28 | $120.48 | $91.68 |
Full-time employees earning $102,300 – $147,000 and part-time employees < $147,000 with more than 5 years of service
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $219.38 | $706.56 | $518.18 | $394.86 |
| YOUR HSA-Eligible Plan | $19.18 | $61.78 | $45.30 | $34.48 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $658.14 | $2,119.68 | $1,554.54 | $1,184.58 |
| YOUR HSA-Eligible Plan | $57.54 | $185.34 | $135.90 | $103.44 |
Part-time employees earning less than $147,000 with less than 5 years of service**
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $274.60 | $884.34 | $648.56 | $494.26 |
| YOUR HSA-Eligible Plan | $84.30 | $271.40 | $199.06 | $151.64 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $823.80 | $2,653.02 | $1,945.68 | $1,482.78 |
| YOUR HSA-Eligible Plan | $252.90 | $814.20 | $597.18 | $454.92 |
Employees earning $147,000 to <$184,600
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $290.06 | $934.22 | $685.12 | $522.12 |
| YOUR HSA-Eligible Plan | $63.66 | $205.02 | $150.36 | $114.56 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $870.18 | $2,802.66 | $2,055.36 | $1,566.36 |
| YOUR HSA-Eligible Plan | $190.98 | $615.06 | $451.08 | $343.68 |
Employees earning $184,600 to <$242,100
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $354.98 | $1,143.36 | $838.48 | $639.02 |
| YOUR HSA-Eligible Plan | $127.16 | $409.54 | $300.34 | $228.82 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $1,064.94 | $3,430.08 | $2,515.44 | $1,917.06 |
| YOUR HSA-Eligible Plan | $381.48 | $1,228.62 | $901.02 | $686.46 |
Employees earning > $242,100
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $410.56 | $1,322.34 | $969.74 | $739.04 |
| YOUR HSA-Eligible Plan | $166.76 | $537.10 | $393.88 | $300.10 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $1,231.68 | $3,967.02 | $2,909.22 | $2,217.12 |
| YOUR HSA-Eligible Plan | $500.28 | $1,611.30 | $1,181.64 | $900.30 |
Dental plans**
Monthly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $4.66 | $9.46 |
| Medallion Dental Plan | $14.56 | $29.82 |
Quarterly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $13.98 | $28.38 |
| Medallion Dental Plan | $43.68 | $89.46 |
* The rates above apply to Faculty/Staff/SEIU members on Long-Term Disability who are not eligible for Medicare. The University Health Care Plan will be primary payer for health care expenses.
** Eligibility rules apply
Share of Premiums for Faculty, Staff, and SEIU Members on Long-Term Disability who are Medicare eligible or are covering a Medicare eligible dependent
Full-time employees earning < $68,900
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $0 | $243.76 | $135.48 | $108.28 |
| YOUR HSA-Eligible Plan | $0 | $24.90 | $13.86 | $11.04 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $0 | $731.28 | $406.44 | $324.84 |
| YOUR HSA-Eligible Plan | $0 | $74.70 | $41.58 | $33.12 |
Full-time employees earning $68,900 to <$102,300
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $65.00 | $425.86 | $265.48 | $225.38 |
| YOUR HSA-Eligible Plan | $3.14 | $33.70 | $20.14 | $16.70 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $195.00 | $1,277.58 | $796.44 | $676.14 |
| YOUR HSA-Eligible Plan | $9.42 | $101.10 | $60.42 | $50.10 |
Full-time employees earning $102,300 – $147,000 and part-time employees < $147,000 with more than 5 years of service
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $83.90 | $478.76 | $303.28 | $259.38 |
| YOUR HSA-Eligible Plan | $5.32 | $39.80 | $24.50 | $20.62 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $251.70 | $1,436.28 | $909.84 | $778.14 |
| YOUR HSA-Eligible Plan | $15.96 | $119.40 | $73.50 | $61.86 |
Part-time employees earning less than $147,000 with less than 5 years of service**
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $139.12 | $633.38 | $413.72 | $358.78 |
| YOUR HSA-Eligible Plan | $70.44 | $222.08 | $154.74 | $137.78 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $417.36 | $1,900.14 | $1,241.16 | $1,076.34 |
| YOUR HSA-Eligible Plan | $211.32 | $666.24 | $464.22 | $413.34 |
Employees earning $147,000 to <$184,600
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $154.58 | $676.70 | $444.64 | $386.64 |
| YOUR HSA-Eligible Plan | $49.80 | $164.36 | $113.46 | $100.70 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $463.74 | $2,030.10 | $1,333.92 | $1,159.92 |
| YOUR HSA-Eligible Plan | $149.40 | $493.08 | $340.38 | $302.10 |
Employees earning $184,600 to <$242,100
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $219.50 | $858.52 | $574.48 | $503.54 |
| YOUR HSA-Eligible Plan | $113.30 | $342.12 | $240.46 | $214.96 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $658.50 | $2,575.56 | $1,723.44 | $1,510.62 |
| YOUR HSA-Eligible Plan | $339.90 | $1,026.36 | $721.38 | $644.88 |
Employees earning > $242,100
Monthly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $275.08 | $1,014.12 | $685.64 | $603.56 |
| YOUR HSA-Eligible Plan | $152.90 | $453.00 | $319.66 | $286.24 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Family | Employee & Spouse/ Domestic Partner | Employee & Child(ren) |
| YOUR PPO Plan | $825.24 | $3,042.36 | $2,056.92 | $1,810.68 |
| YOUR HSA-Eligible Plan | $458.70 | $1359.00 | $958.98 | $858.72 |
Dental plans**
Monthly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $4.66 | $9.46 |
| Medallion Dental Plan | $14.56 | $29.82 |
Quarterly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $13.98 | $28.38 |
| Medallion Dental Plan | $43.68 | $89.46 |
* The rates above apply to Faculty/Staff/SEIU members on Long-Term Disability who are Medicare-eligible or whose dependents are Medicare-eligible. For the Medicare-eligible member only, Medicare is the primary payer for health care expenses and the University Health Care Plans are the secondary payer. Therefore, the University Health Care Plans will not cover any expenses that would have been covered under Medicare Part A and Part B if the Medicare-eligible member were enrolled (commonly known as “carve out” plans). The University Health Care Plans will continue to be primary payer of health care expenses for members not eligible for Medicare.
** Eligibility rules apply
January 1–December 31, 2025
Share of Premiums for Faculty, Staff, and SEIU Members on Long-Term Disability who are Medicare-eligible and whose spouse or domestic partner are also Medicare-eligible*
Full-Time Employees Earning < $71,000
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 $71,000- < $105,400
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $62.30 | $124.60 |
| YOUR HSA-Eligible Plan | $3.74 | $7.48 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $186.90 | $373.80 |
| YOUR HSA-Eligible Plan | $11.22 | $22.44 |
Full-Time Employees Earning $105,400-< $151,400 AND Part-Time Employees Earning < $151,400 with more than 5 years of service
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $92.60 | $185.20 |
| YOUR HSA-Eligible Plan | $7.54 | $15.08 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $277.80 | $555.60 |
| YOUR HSA-Eligible Plan | $22.62 | $45.24 |
Part-time employees earning < $151,400 with less than 5 years of service
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $157.68 | $315.36 |
| YOUR HSA-Eligible Plan | $79.84 | $159.68 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $473.04 | $946.08 |
| YOUR HSA-Eligible Plan | $239.52 | $479.04 |
Employees Earning $151,400- < $190,100
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $178.50 | $357.00 |
| YOUR HSA-Eligible Plan | $49.86 | $99.72 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $535.50 | $1,071.00 |
| YOUR HSA-Eligible Plan | $149.58 | $299.16 |
Employees Earning $190,100- < $249,400
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $268.92 | $537.84 |
| YOUR HSA-Eligible Plan | $115.26 | $230.52 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $806.76 | $1,613.52 |
| YOUR HSA-Eligible Plan | $345.78 | $691.56 |
Employees Earning $249,400+
Monthly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $367.64 | $735.28 |
| YOUR HSA-Eligible Plan | $177.08 | $354.16 |
Quarterly Premium Contributions
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner |
| YOUR PPO Plan | $1,102.92 | $2,205.84 |
| YOUR HSA-Eligible Plan | $531.24 | $1,062.48 |
Dental plans**
Monthly Rates
| University Dental Plans |
Single | Family |
| Traditional Dental Plan | $4.78 | $9.70 |
| Medallion Dental Plan | $14.94 | $30.58 |
Quarterly Rates
| University Dental Plans** |
Single | Family |
| Traditional Dental Plan | $14.34 | $29.10 |
| Medallion Dental Plan | $44.82 | $91.74 |
* 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
Share of Premiums for Faculty, Staff, and SEIU Members on Long-Term Disability and both Member and Spouse/Domestic Partner are NON-Medicare eligible*
Full-Time Employees Earning < $71,000
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $153.58 | $362.68 | $276.3 | $494.52 |
| YOUR HSA-Eligible Plan | $15.72 | $37.08 | $28.22 | $50.54 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $460.74 | $1,088.04 | $828.90 | $1,483.56 |
| YOUR HSA-Eligible Plan | $47.16 | $111.24 | $84.66 | $151.62 |
Full-Time Employees Earning $71,000- < $105,400
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $215.88 | $509.94 | $388.58 | $695.34 |
| YOUR HSA-Eligible Plan | $19.46 | $45.98 | $35.00 | $62.70 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $647.64 | $1,529.82 | $1,165.74 | $2,086.02 |
| YOUR HSA-Eligible Plan | $58.38 | $137.94 | $105.00 | $188.10 |
Full-Time Employees Earning $105,400-< $151,400 AND Part-Time Employees Earning < $151,400 with more than 5 years of service
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $246.18 | $581.48 | $443.1 | $792.88 |
| YOUR HSA-Eligible Plan | $23.26 | $54.94 | $41.82 | $74.94 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $738.54 | $1,744.44 | $1,329.30 | $2,378.64 |
| YOUR HSA-Eligible Plan | $69.78 | $164.82 | $125.46 | $224.82 |
Part-time employees earning < $151,400 with less than 5 years of service
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $311.26 | $735.14 | $560.24 | $1002.4 |
| YOUR HSA-Eligible Plan | $95.56 | $225.64 | $171.88 | $307.64 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $933.78 | $2,205.42 | $1,680.72 | $3,007.20 |
| YOUR HSA-Eligible Plan | $286.68 | $676.92 | $515.64 | $922.92 |
Employees Earning $151,400- < $190,100
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $332.08 | $784.36 | $597.74 | $1,069.54 |
| YOUR HSA-Eligible Plan | $65.58 | $154.88 | $118 | $211.18 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $996.24 | $2,353.08 | $1,793.22 | $3,208.62 |
| YOUR HSA-Eligible Plan | $196.74 | $464.64 | $354.00 | $633.54 |
Employees Earning $190,100- < $249,400
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $422.50 | $997.94 | $760.56 | $1,360.8 |
| YOUR HSA-Eligible Plan | $130.98 | $309.36 | $235.68 | $421.84 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $1,267.50 | $2,993.82 | $2,281.68 | $4,082.40 |
| YOUR HSA-Eligible Plan | $392.94 | $928.08 | $707.04 | $1,265.52 |
Employees Earning $249,400+
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $521.22 | $1,231.10 | $938.24 | $1,678.74 |
| YOUR HSA-Eligible Plan | $192.8 | $455.4 | $346.98 | $620.98 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $1,563.66 | $3,693.30 | $2,814.72 | $5,036.22 |
| YOUR HSA-Eligible Plan | $578.40 | $1,366.20 | $1,040.94 | $1,862.94 |
Dental plans**
Monthly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $4.78 | $9.70 |
| Medallion Dental Plan | $14.94 | $30.58 |
Quarterly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $14.34 | $29.10 |
| Medallion Dental Plan | $44.82 | $91.74 |
* The rates above apply to Faculty/Staff/SEIU members on Long-Term Disability who are not eligible for Medicare. The University Health Care Plan will be primary payer for health care expenses.
† Eligibility rules apply
Share of Premiums for Faculty, Staff, and SEIU Members on Long-Term Disability who are Medicare eligible or are covering a Medicare eligible dependent
Full-Time Employees Earning < $71,000
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $0.00 | $153.58 | $122.72 | $276.3 |
| YOUR HSA-Eligible Plan | $0.00 | $15.72 | $12.5 | $28.22 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $0.00 | $460.74 | $368.16 | $828.90 |
| YOUR HSA-Eligible Plan | $0.00 | $47.16 | $37.50 | $84.66 |
Full-Time Employees Earning $71,000- < $105,400
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $62.30 | $278.18 | $235 | $450.88 |
| YOUR HSA-Eligible Plan | $3.74 | $23.2 | $19.28 | $38.74 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $186.90 | $834.54 | $705.00 | $1,352.64 |
| YOUR HSA-Eligible Plan | $11.22 | $69.60 | $57.84 | $116.22 |
Full-Time Employees Earning $105,400-< $151,400 AND Part-Time Employees Earning < $151,400 with more than 5 years of service
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $92.60 | $338.78 | $289.52 | $535.7 |
| YOUR HSA-Eligible Plan | $7.54 | $30.80 | $26.10 | $49.36 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $277.80 | $1,016.34 | $868.56 | $1,607.10 |
| YOUR HSA-Eligible Plan | $22.62 | $92.40 | $78.30 | $148.08 |
Part-time employees earning < $151,400 with less than 5 years of service
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $157.68 | $468.94 | $406.66 | $717.92 |
| YOUR HSA-Eligible Plan | $79.84 | $175.40 | $156.16 | $251.72 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $473.04 | $1,406.82 | $1,219.98 | $2,153.76 |
| YOUR HSA-Eligible Plan | $239.52 | $526.20 | $468.48 | $755.16 |
Employees Earning $151,400- < $190,100
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $178.50 | $510.58 | $444.16 | $776.24 |
| YOUR HSA-Eligible Plan | $49.86 | $115.44 | $102.28 | $167.86 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $535.50 | $1,531.74 | $1,332.48 | $2,328.72 |
| YOUR HSA-Eligible Plan | $149.58 | $346.32 | $306.84 | $503.58 |
Employees Earning $190,100- < $249,400
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $268.92 | $691.42 | $606.98 | $1,029.48 |
| YOUR HSA-Eligible Plan | $115.26 | $246.24 | $219.96 | $350.94 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $806.76 | $2,074.26 | $1,820.94 | $3,088.44 |
| YOUR HSA-Eligible Plan | $345.78 | $738.72 | $659.88 | $1,052.82 |
Employees Earning $249,400+
Monthly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $367.64 | $888.86 | $784.66 | $1,305.88 |
| YOUR HSA-Eligible Plan | $177.08 | $369.88 | $331.26 | $524.06 |
Quarterly Premium Contribution
| University Health Care Plans | Single | Employee & Spouse/ Domestic Partner | Employee & Child(ren) | Family |
| YOUR PPO Plan | $1,102.92 | $2,666.58 | $2,353.98 | $3,917.64 |
| YOUR HSA-Eligible Plan | $531.24 | $1,109.64 | $993.78 | $1,572.18 |
Dental plans**
Monthly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $4.78 | $9.70 |
| Medallion Dental Plan | $14.94 | $30.58 |
Quarterly Premium Contribution
| University Dental Plans | Single | Family |
| Traditional Dental Plan | $14.34 | $29.10 |
| Medallion Dental Plan | $44.82 | $91.74 |
* The rates above apply to Faculty/Staff/SEIU members on Long-Term Disability who are Medicare-eligible or whose dependents are Medicare-eligible. For the Medicare-eligible member only, Medicare is the primary payer for health care expenses and the University Health Care Plans are the secondary payer. Therefore, the University Health Care Plans will not cover any expenses that would have been covered under Medicare Part A and Part B if the Medicare-eligible member were enrolled (commonly known as “carve out” plans). The University Health Care Plans will continue to be primary payer of health care expenses for members not eligible for Medicare.
† Eligibility rules apply