Choose Your Appropriate Wellness $$ Level
| Level | Amount | Requirements Completed |
|---|---|---|
| Full ($500/ee) Wellness $$ | Additional $41.66/mo | Biometric Screening, Health Assessment, Non-Tobacco User (completed affidavit) |
| Partial ($250) Wellness $$ | Additional $20.83/mo | Biometric Screening, Health Assessment, Tobacco Use (did not choose “reasonable alternative”) |
| No Wellness $$ | No Additional $$ | Did Not Take Biometric Screening/Health Assessment |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $718.02 | $640.11 | $77.91 |
| Employee & Spouse | $1,499.06 | $892.72 | $606.34 |
| Employee & Children | $1,282.27 | $858.30 | $423.97 |
| Family | $1,951.87 | $989.34 | $962.53 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $595.32 | $640.11 | ($44.79)* |
| Employee & Spouse | $1,242.89 | $892.72 | $350.17 |
| Employee & Children | $1,063.13 | $858.30 | $204.83 |
| Family | $1,618.33 | $989.34 | $628.99 |
* 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 | $547.32 | $640.11 | ($92.79)* |
| Employee & Spouse | $1,142.68 | $892.72 | $249.96 |
| Employee & Children | $977.43 | $858.30 | $119.13 |
| Family | $1,487.86 | $989.34 | $498.52 |
* 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 $83.33/month to an H.S.A. account for employee only. And $166.67/month to an H.S.A. for those enrolled in dependent tiers.
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $718.02 | $619.28 | $98.74 |
| Employee & Spouse | $1,499.06 | $871.89 | $627.17 |
| Employee & Children | $1,282.27 | $837.47 | $444.80 |
| Family | $1,951.87 | $968.51 | $983.36 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $595.32 | $619.28 | ($23.96)* |
| Employee & Spouse | $1,242.89 | $871.89 | $371.00 |
| Employee & Children | $1,063.13 | $837.47 | $225.66 |
| Family | $1,618.33 | $968.51 | $649.82 |
* 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 | $547.32 | $619.28 | ($71.96)* |
| Employee & Spouse | $1,142.68 | $871.89 | $270.79 |
| Employee & Children | $977.43 | $837.47 | $139.96 |
| Family | $1,487.86 | $968.51 | $519.35 |
*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 $83.33/month to an H.S.A. account for employee only. And $166.67/month to an H.S.A. for those enrolled in dependent tiers.
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $718.02 | $598.45 | $119.57 |
| Employee & Spouse | $1,499.06 | $851.06 | $648.00 |
| Employee & Children | $1,282.27 | $816.64 | $465.63 |
| Family | $1,951.87 | $947.68 | $1,004.19 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $595.32 | $598.45 | ($3.13)* |
| Employee & Spouse | $1,242.89 | $851.06 | $391.83 |
| Employee & Children | $1,063.13 | $816.64 | $246.49 |
| Family | $1,618.33 | $947.68 | $670.65 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $547.32 | $598.45 | ($51.13)* |
| Employee & Spouse | $1,142.68 | $851.06 | $291.62 |
| Employee & Children | $977.43 | $816.64 | $160.79 |
| Family | $1,487.86 | $947.68 | $540.18 |
*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 $83.33/month to an H.S.A. account for employee only. And $166.67/month to an H.S.A. for those enrolled in dependent tiers.