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 | $1,058.13 | $891.08 | $167.05 |
| Employee & Spouse | $2,209.15 | $1,243.76 | $965.39 |
| Employee & Children | $1,889.67 | $1,195.71 | $693.96 |
| Family | $2,876.44 | $1,378.65 | $1,497.79 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $835.53 | $891.08 | ($55.55)* |
| Employee & Spouse | $1,744.41 | $1,243.76 | $500.65 |
| Employee & Children | $1,492.11 | $1,195.71 | $296.40 |
| Family | $2,271.35 | $1,378.65 | $892.70 |
* 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 | $768.17 | $891.08 | ($122.91)* |
| Employee & Spouse | $1,603.76 | $1,243.76 | $360.00 |
| Employee & Children | $1,371.83 | $1,195.71 | $176.12 |
| Family | $2,088.23 | $1,378.65 | $709.58 |
* 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 | $1,058.13 | $863.31 | $194.82 |
| Employee & Spouse | $2,209.15 | $1,215.99 | $993.16 |
| Employee & Children | $1,889.67 | $1,167.93 | $721.74 |
| Family | $2,876.44 | $1,350.88 | $1,525.56 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $835.53 | $863.31 | ($27.78)* |
| Employee & Spouse | $1,744.41 | $1,215.99 | $528.42 |
| Employee & Children | $1,492.11 | $1,167.93 | $324.18 |
| Family | $2,271.35 | $1,350.88 | $920.47 |
* 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 | $768.17 | $863.31 | ($95.14)* |
| Employee & Spouse | $1,603.76 | $1,215.99 | $387.77 |
| Employee & Children | $1,371.83 | $1,167.93 | $203.90 |
| Family | $2,088.23 | $1,350.88 | $737.35 |
* 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 $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 | $1,058.13 | $835.53 | $222.60 |
| Employee & Spouse | $2,209.15 | $1,188.21 | $1,020.94 |
| Employee & Children | $1,889.67 | $1,140.16 | $749.51 |
| Family | $2,876.44 | $1,323.11 | $1,553.33 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $835.53 | $835.53 | $0 |
| Employee & Spouse | $1,744.41 | $1,188.21 | $556.20 |
| Employee & Children | $1,492.11 | $1,140.16 | $351.95 |
| Family | $2,271.35 | $1,323.11 | $948.24 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $768.17 | $835.53 | ($67.36)* |
| Employee & Spouse | $1,603.76 | $1,188.21 | $415.55 |
| Employee & Children | $1,371.83 | $1,140.16 | $231.67 |
| Family | $2,088.23 | $1,323.11 | $765.12 |
* 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.