EFFECTIVE JANUARY 1, 2008
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 $266.00 $168.00
Employee Plus One $ 945.00 $ 264.00 $266.00 $415.00
Employee and
Family $1,240.00
$ 344.00 $266.00 $630.00
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 $266.00 $185.00
Employee Plus One $ 945.00 $ 234.00 $266.00 $445.00
Employee and
Family $1,240.00
$ 304.00 $266.00 $670.00
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 $266.00 $202.00
Employee Plus One $ 945.00 $ 204.00 $266.00 $475.00
Employee and Family $1,240.00 $ 264.00 $266.00 $710.00
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 $354.67 $ 223.33
Employee Plus One $1,260.00 $ 352.00 $354.67 $ 553.33
Employee and
Family $ 1,653.00 $
459.00 $354.67
$ 839.33
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 $354.67 $ 246.33
Employee Plus One $1,260.00 $ 312.00 $354.67 $ 593.33
Employee and
Family $1,653.00
$ 405.00 $354.67
$ 893.33
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 $354.67 $ 269.33
Employee Plus One $1,260.00 $ 272.00 $354.67 $ 633.33
Employee and Family $1,653.00 $ 352.00 $354.67 $ 946.33
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 $133.00 $ 84.00
Employee Plus One $ 473.00 $ 132.00 $133.00 $ 208.00
Employee and
Family $
620.00 $
172.00 $133.00 $
315.00
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 $133.00 $ 93.00
Employee Plus One $ 473.00 $ 117.00 $133.00 $ 223.00
Employee and
Family $
620.00 $
152.00 $133.00 $
335.00
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 $133.00 $101.00
Employee Plus One $ 473.00 $102.00 $133.00 $ 238.00
Employee and Family $ 620.00 $132.00 $133.00 $ 355.00
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 $266.00 $ 108.00
Employee Plus One $ 855.00 $ 264.00 $266.00 $ 325.00
Employee and
Family $1,120.00
$ 344.00 $266.00 $510.00
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 $266.00 $ 125.00
Employee Plus One $ 855.00 $ 234.00 $266.00 $ 355.00
Employee and
Family $1,120.00
$ 304.00 $266.00 $
550.00
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 $266.00 $ 142.00
Employee Plus One $ 855.00 $ 204.00 $266.00 $ 385.00
Employee and Family $1,120.00 $ 264.00 $266.00 $ 590.00
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 $354.67 $ 143.33
Employee Plus One $1,140.00 $ 352.00 $354.67 $ 433.33
Employee and
Family $1,493.00
$ 459.00 $354.67
$ 679.33
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 $354.67 $ 166.33
Employee Plus One $ 1,140.00 $ 312.00 $354.67 $ 473.33
Employee and
Family $1,493.00 $
405.00 $354.67
$ 733.33
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 $354.67 $ 189.33
Employee Plus One $1,140.00 $ 272.00 $354.67 $ 513.33
Employee and Family $1,493.00 $ 352.00 $354.67 $ 776.33
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 $133.00 $ 54.00
Employee Plus One $ 428.00 $ 132.00 $133.00 $ 163.00
Employee and
Family $
560.00 $
172.00 $133.00 $
255.00
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 $133.00 $ 63.00
Employee Plus One $ 428.00 $ 117.00 $133.00 $ 178.00
Employee and
Family $
560.00 $
152.00 $133.00
$ 275.00
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 $133.00 $ 71.00
Employee Plus One $ 428.00 $ 102.00 $133.00 $ 193.00
Employee and Family $ 560.00 $ 132.00 $133.00 $ 295.00
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 $266.00 $ 63.00
Employee Plus One $ 780.00 $ 264.00 $266.00 $250.00
Employee and Family $1,020.00 $ 344.00 $266.00 $410.00
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 $266.00 $ 80.00
Employee Plus One $ 780.00 $ 234.00 $266.00 $280.00
Employee and Family $1,020.00 $ 304.00 $266.00 $450.00
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 $266.00 $ 97.00
Employee Plus One $ 780.00 $204.00 $266.00 $310.00
Employee and Family $1,020.00 $264.00 $266.00 $490.00
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 $354.67 $ 83.33
Employee Plus One $1,040.00 $ 352.00 $354.67 $333.33
Employee and Family $1,360.00 $ 459.00 $354.67 $546.33
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 $354.67 $106.33
Employee Plus One $1,040.00 $ 312.00 $354.67 $373.33
Employee and Family $1,360.00 $ 405.00 $354.67 $600.33
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 $354.67 $129.33
Employee Plus One $1,040.00 $272.00 $354.67 $413.33
Employee and Family $1,360.00 $352.00 $354.67 $653.33
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 $133.00 $ 31.00
Employee Plus One $ 390.00 &nbs