EFFECTIVE JANUARY 1, 2007
MEDICAL PREMIUMS – AETNA 90 PLAN
MONTHLY (12 MONTHS)
Tier 1
SALARY UNDER $25,000
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 595.00 $ 161.00 $256.00 $178.00
Employee Plus One $ 945.00 $ 264.00 $256.00 $425.00
Employee and
Family $1,240.00
$ 344.00 $256.00 $640.00
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 595.00 $ 144.00 $256.00 $195.00
Employee Plus One $ 945.00 $ 234.00 $256.00 $455.00
Employee and
Family $1,240.00
$ 304.00 $256.00 $680.00
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 595.00 $ 127.00 $256.00 $212.00
Employee Plus One $ 945.00 $ 204.00 $256.00 $485.00
Employee and Family $1,240.00 $ 264.00 $256.00 $720.00
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $17.78
Employee Plus One $28.34
Employee and Family $37.12
MEDICAL PREMIUMS – AETNA 90 PLAN
MONTHLY (9 MONTHS)
Tier 1
SALARY UNDER $25,000
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 793.00 $ 215.00 $341.33 $ 236.67
Employee Plus One $1,260.00 $ 352.00 $341.33 $ 566.67
Employee and
Family $ 1,653.00 $
459.00 $341.33 $
852.67
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 793.00 $ 192.00 $341.33 $ 259.67
Employee Plus One $1,260.00 $ 312.00 $341.33 $ 606.67
Employee and
Family $1,653.00
$ 405.00 $341.33 $
906.67
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 793.00 $ 169.00 $341.33 $ 282.67
Employee Plus One $1,260.00 $ 272.00 $341.33 $ 646.67
Employee and Family $1,653.00 $ 352.00 $341.33 $ 959.67
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $23.71
Employee Plus One $37.79
Employee and Family $49.49
MEDICAL PREMIUMS – AETNA 90 PLAN
24 PAY PERIODS
Tier 1
SALARY UNDER $25,000
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 298.00 $ 81.00 $128.00 $ 89.00
Employee Plus One $ 473.00 $ 132.00 $128.00 $ 213.00
Employee and
Family $
620.00 $
172.00 $128.00 $
320.00
Tier 2
SALARY $25,000 TO $49,999
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 298.00 $ 72.00 $128.00 $ 98.00
Employee Plus One $ 473.00 $ 117.00 $128.00 $ 228.00
Employee and
Family $
620.00 $
152.00 $128.00 $
340.00
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 298.00 $ 64.00 $128.00 $106.00
Employee Plus One $ 473.00 $102.00 $128.00 $ 243.00
Employee and Family $ 620.00 $132.00 $128.00 $ 360.00
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $ 8.89
Employee Plus One $14.17
Employee and Family $18.56
MEDICAL PREMIUMS – AETNA 80 PLAN
MONTHLY (12 MONTHS)
Tier 1
SALARY UNDER $25,000
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 535.00 $ 161.00 $256.00 $ 118.00
Employee Plus One $ 855.00 $ 264.00 $256.00 $ 335.00
Employee and
Family $1,120.00
$ 344.00 $256.00 $520.00
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 535.00 $ 144.00 $256.00 $ 135.00
Employee Plus One $ 855.00 $ 234.00 $256.00 $ 365.00
Employee and
Family $1,120.00
$ 304.00 $256.00 $
560.00
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 535.00 $ 127.00 $256.00 $ 152.00
Employee Plus One $ 855.00 $ 204.00 $256.00 $ 395.00
Employee and Family $1,120.00 $ 264.00 $256.00 $ 600.00
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $17.78
Employee Plus One $28.34
Employee and Family $37.12
MEDICAL PREMIUMS – AETNA 80 PLAN
MONTHLY (9 MONTHS)
Tier 1
SALARY UNDER $25,000
LESS COST
COVERAGE GROSS UNIVERSITY LESS TO
LEVEL PREMIUM CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 713.00 $ 215.00 $341.33 $ 156.677
Employee Plus One $1,140.00 $ 352.00 $341.33 $ 446.67
Employee and
Family $1,493.00
$ 459.00 $341.33 $
692.67
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 713.00 $ 192.00 $341.33 $ 179.67
Employee Plus One $ 1,140.00 $ 312.00 $341.33 $ 486.67
Employee and
Family $1,493.00 $
405.00 $341.33 $
746.67
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 713.00 $ 169.00 $341.33 $ 202.67
Employee Plus One $1,140.00 $ 272.00 $341.33 $ 526.67
Employee and Family $1,493.00 $ 352.00 $341.33 $ 799.67
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $23.71
Employee Plus One $37.79
Employee and Family $49.49
MEDICAL PREMIUMS – AETNA 80 PLAN
24 PAY PERIODS
Tier 1
SALARY UNDER $25,000
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 268.00 $ 81.00 $128.00 $ 59.00
Employee Plus One $ 428.00 $ 132.00 $128.00 $ 168.00
Employee and
Family $
560.00 $
172.00 $128.00 $
260.00
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 268.00 $ 72.00 $128.00 $ 68.00
Employee Plus One $ 428.00 $ 117.00 $128.00 $ 183.00
Employee and
Family $
560.00 $
152.00 $128.00
$ 280.00
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 268.00 $ 64.00 $128.00 $ 76.00
Employee Plus One $ 428.00 $ 102.00 $128.00 $ 198.00
Employee and Family $ 560.00 $ 132.00 $128.00 $ 300.00
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $ 8.89
Employee Plus One $14.17
Employee and Family $18.56
MEDICAL PREMIUMS – AETNA 70 PLAN
MONTHLY (12 MONTHS)
Tier 1
SALARY UNDER $25,000
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $490.00 $ 161.00 $256.00 $ 73.00
Employee Plus One $ 780.00 $ 264.00 $256.00 $260.00
Employee and Family $1,020.00 $ 344.00 $256.00 $420.00
Tier 2
SALARY $25,000 TO $49,999
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 490.00 $ 144.00 $256.00 $ 90.00
Employee Plus One $ 780.00 $ 234.00 $256.00 $290.00
Employee and Family $1,020.00 $ 304.00 $256.00 $460.00
Tier 3
SALARY $50,000 AND ABOVE
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 490.00 $127.00 $256.00 $107.00
Employee Plus One $ 780.00 $204.00 $256.00 $320.00
Employee and Family $1,020.00 $264.00 $256.00 $500.00
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $17.78
Employee Plus One $28.34
Employee and Family $37.12
MEDICAL PREMIUMS – AETNA 70 PLAN
MONTHLY (9 MONTHS)
Tier 1
SALARY UNDER $25,000
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 653.00 $ 215.00 $341.33 $ 96.67
Employee Plus One $1,040.00 $ 352.00 $341.33 $346.67
Employee and Family $1,360.00 $ 459.00 $341.33 $559.67
Tier 2
SALARY $25,000 TO $49,999
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 653.00 $ 192.00 $341.33 $119.67
Employee Plus One $1,040.00 $ 312.00 $341.33 $386.67
Employee and Family $1,360.00 $ 405.00 $341.33 $613.67
Tier 3
SALARY $50,000 AND ABOVE
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 653.00 $169.00 $341.33 $142.67
Employee Plus One $1,040.00 $272.00 $341.33 $426.67
Employee and Family $1,360.00 $352.00 $341.33 $666.67
PRESCRIPTION BUY-UP PLAN RATES
Employee Only $23.71
Employee Plus One $37.79
Employee and Family $49.49
MEDICAL PREMIUMS – AETNA 70 PLAN
24 PAY PERIODS
Tier 1
SALARY UNDER $25,000
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 245.00 $ 81.00 $128.00 $ 36.00
Employee Plus One $ 390.00