EFFECTIVE JANUARY 1, 2009
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 $ 613.00 $ 166.00 $274.00 $173.00
Employee Plus One $ 973.00 $ 272.00 $274.00 $427.00
Employee and
Family $1,277.00
$ 354.00 $274.00 $649.00
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 613.00 $ 148.00 $274.00 $191.00
Employee Plus One $ 973.00 $ 241.00 $274.00 $458.00
Employee and
Family $1,277.00
$ 313.00 $274.00 $690.00
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 613.00 $ 131.00 $274.00 $208.00
Employee Plus One $ 973.00 $ 210.00 $274.00 $489.00
Employee and Family $1,277.00 $ 272.00 $274.00 $731.00
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 $ 817.00 $ 221.00 $365.33 $ 230.67
Employee Plus One $1,297.00 $ 363.00 $365.33 $ 568.67
Employee and
Family $ 1,703.00 $
472.00 $365.33
$ 865.67
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 817.00 $ 197.00 $365.33 $ 254.67
Employee Plus One $1,297.00 $ 321.00 $365.33 $ 610.67
Employee and
Family $1,703.00
$ 417.00 $365.33
$ 920.67
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 817.00 $ 175.00 $365.33 $ 276.67
Employee Plus One $1,297.00 $ 280.00 $365.33 $ 651.67
Employee and Family $1,703.00 $ 363.00 $365.33 $ 974.67
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 $ 306.50 $ 83.00 $137.00 $ 86.50
Employee Plus One $ 486.50 $ 136.00 $137.00 $ 213.50
Employee and
Family $
638.50 $
177.00 $137.00
$ 324.50
Tier 2
SALARY $25,000 TO $49,999
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 306.50 $ 74.00 $137.00 $ 95.50
Employee Plus One $ 486.50 $ 120.50 $137.00 $ 229.00
Employee and
Family $
638.50 $
156.50 $137.00 $
345.00
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 306.50 $ 65.50 $137.00 $104.00
Employee Plus One $ 486.50 $105.00 $137.00 $ 244.50
Employee and Family $ 638.50 $136.00 $137.00 $ 365.50
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 $ 551.00 $ 166.00 $274.00 $ 111.00
Employee Plus One $ 881.00 $ 272.00 $274.00 $ 335.00
Employee and
Family $1,154.00
$ 354.00 $274.00 $526.00
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 551.00 $ 148.00 $274.00 $ 129.00
Employee Plus One $ 881.00 $ 241.00 $274.00 $ 366.00
Employee and
Family $1,154.00
$ 313.00 $274.00 $
567.00
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 551.00 $ 131.00 $274.00 $ 146.00
Employee Plus One $ 881.00 $ 210.00 $274.00 $ 397.00
Employee and Family $1,154.00 $ 272.00 $274.00 $ 608.00
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 $ 734.00 $ 221.00 $365.33 $ 147.67
Employee Plus One $1,174.00 $ 363.00 $365.33 $ 445.67
Employee and
Family $1,538.00
$ 472.00 $365.33 $ 700.67
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 734.00 $ 197.00 $365.33 $ 171.67
Employee Plus One $ 1,174.00 $ 321.00 $365.33 $ 487.67
Employee and
Family $1,538.00 $
417.00 $365.33
$ 755.67
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 734.00 $ 175.00 $365.33 $ 193.67
Employee Plus One $1,174.00 $ 280.00 $365.33 $ 528.67
Employee and Family $1,538.00 $ 363.00 $365.33 $ 809.67
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 $ 275.50 $ 83.00 $137.00 $ 55.50
Employee Plus One $ 440.50 $ 136.00 $137.00 $ 167.50
Employee and
Family $
577.00 $
177.00 $137.00
$ 263.00
Tier 2
SALARY $25,000 TO $49,999
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 275.50 $ 74.00 $137.00 $ 64.50
Employee Plus One $ 440.50 $ 120.50 $137.00 $ 183.00
Employee and
Family $
577.00 $
156.50 $137.00
$ 283.50
Tier 3
SALARY $50,000 AND ABOVE
LESS COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 275.50 $ 65.50 $137.00 $ 73.00
Employee Plus One $ 440.50 $ 105.00 $137.00 $ 198.50
Employee and Family $ 577.00 $ 136.00 $137.00 $ 304.00
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 $505.00 $ 166.00 $274.00 $ 65.00
Employee Plus One $ 803.00 $ 272.00 $274.00 $257.00
Employee and Family $1,051.00 $ 354.00 $274.00 $423.00
Tier 2
SALARY $25,000 TO $49,999
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 505.00 $ 148.00 $274.00 $ 83.00
Employee Plus One $ 803.00 $ 241.00 $274.00 $288.00
Employee and Family $1,051.00 $ 313.00 $274.00 $464.00
Tier 3
SALARY $50,000 AND ABOVE
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 505.00 $131.00 $274.00 $100.00
Employee Plus One $ 803.00 $210.00 $274.00 $319.00
Employee and Family $1,051.00 $272.00 $274.00 $505.00
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 $ 673.00 $ 221.00 $365.33 $ 86.67
Employee Plus One $1,070.00 $ 363.00 $365.33 $341.67
Employee and Family $1,401.00 $ 472.00 $365.33 $563.67
Tier 2
SALARY $25,000 TO $49,999
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 673.00 $ 197.00 $365.33 $110.67
Employee Plus One $1,070.00 $ 321.00 $365.33 $383.67
Employee and Family $1,401.00 $ 417.00 $365.33 $618.67
Tier 3
SALARY $50,000 AND ABOVE
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 673.00 $175.00 $365.33 $132.67
Employee Plus One $1,070.00 $280.00 $365.33 $424.67
Employee and Family $1,401.00 $363.00 $365.33 $672.67
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 $ 252.50 $ 83.00 $137.00 $ 32.50
Employee Plus One $ 401.50 $136.00 $137.00 $128.50
Employee and Family $ 525.50 $177.00 $137.00 $211.50
Tier 2
SALARY $25,000 TO $49,999
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 252.50 $ 74.00 $137.00 $ 41.50
Employee Plus One $ 401.50 $120.50 $137.00 $144.00
Employee and Family $ 525.50 $156.50 $137.00 $232.00
Tier 3
SALARY $50,000 AND ABOVE
LESS
COST
COVERAGE GROSS UNIVERSITY
LESS TO
LEVEL PREMIUM
CONTRIBUTION FLEX $ EMPLOYEE
Employee Only $ 252.50 $ 65.50 $137.00 $ 50.00
Employee Plus One $ 401.50 $105.00 $137.00 $159.50
Employee and Family $ 525.50 $136.00 $137.00 $252.50
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