Choose Your Appropriate Wellness $$ Level
| Level | Amount | Requirements Completed |
|---|---|---|
| Full ($500/ee) Wellness $$ | Additional $55.55/mo | Biometric Screening, Health Assessment, Non-Tobacco User (completed affidavit) |
| Partial ($250) Wellness $$ | Additional $27.77/mo | Biometric Screening, Health Assessment, Tobacco Use (did not choose “reasonable alternative”) |
| No Wellness $$ | No Additional $$ | Did Not Take Biometric Screening/Health Assessment |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $957.36 | $853.48 | $103.88 |
| Employee & Spouse | $1,998.75 | $1,190.29 | $808.46 |
| Employee & Children | $1,709.69 | $1,144.40 | $565.29 |
| Family | $2,602.49 | $1,319.12 | $1,283.37 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $793.76 | $853.48 | ($59.72)* |
| Employee & Spouse | $1,657.19 | $1,190.29 | $466.90 |
| Employee & Children | $1,417.51 | $1,144.40 | $273.11 |
| Family | $2,157.77 | $1,319.12 | $838.65 |
* Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $729.76 | $853.48 | ($123.72)* |
| Employee & Spouse | $1,523.57 | $1,190.29 | $333.28 |
| Employee & Children | $1,303.24 | $1,144.40 | $158.84 |
| Family | $1,983.81 | $1,319.12 | $664.69 |
* Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).
Per revised IRS regulations, excess University Contributions may no longer be added to H.S.A. account each month.
H.S.A Participants – The University will contribute $111.11/month to an H.S.A. account for employee only. And $222.22/month to an H.S.A. for those enrolled in dependent tiers.
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $957.36 | $825.71 | $131.65 |
| Employee & Spouse | $1,998.75 | $1,162.52 | $836.23 |
| Employee & Children | $1,709.69 | $1,116.63 | $593.06 |
| Family | $2,602.49 | $1,291.35 | $1,311.14 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $793.76 | $825.71 | ($31.95)* |
| Employee & Spouse | $1,657.19 | $1,162.52 | $494.67 |
| Employee & Children | $1,417.51 | $1,116.63 | $300.88 |
| Family | $2,157.77 | $1,291.35 | $866.42 |
* Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $729.76 | $825.71 | ($95.95)* |
| Employee & Spouse | $1,523.57 | $1,162.52 | $361.05 |
| Employee & Children | $1,303.24 | $1,116.63 | $186.61 |
| Family | $1,983.81 | $1,291.35 | $692.46 |
* Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).
Per revised IRS regulations, excess University Contributions may no longer be added to H.S.A. account each month.
H.S.A Participants – The University will contribute $111.11/month to an H.S.A. account for employee only. And $222.22/month to an H.S.A. for those enrolled in dependent tiers.
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $957.36 | $797.93 | $159.43 |
| Employee & Spouse | $1,998.75 | $1,134.74 | $864.01 |
| Employee & Children | $1,709.69 | $1,088.85 | $620.84 |
| Family | $2,602.49 | $1,263.57 | $1,338.92 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $793.76 | $797.93 | ($4.17)* |
| Employee & Spouse | $1,657.19 | $1,134.74 | $522.45 |
| Employee & Children | $1,417.51 | $1,088.85 | $328.66 |
| Family | $2,157.77 | $1,263.57 | $894.20 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $729.76 | $797.93 | ($68.17)* |
| Employee & Spouse | $1,523.57 | $1,134.74 | $388.83 |
| Employee & Children | $1,303.24 | $1,088.85 | $214.39 |
| Family | $1,983.81 | $1,263.57 | $720.24 |
* Employee may use excess University Contributions for qualifying dental elections. If dental coverage
is also employee only, excess contributions will cover Plan B (high option).
Per revised IRS regulations, excess University Contributions may no longer be added to H.S.A. account each month.
H.S.A Participants – The University will contribute $111.11/month to an H.S.A. account for employee only. And $222.22/month to an H.S.A. for those enrolled in dependent tiers.