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 | $793.60 | $668.31 | $125.29 |
| Employee & Spouse | $1,656.86 | $932.82 | $724.04 |
| Employee & Children | $1,417.25 | $896.78 | $520.47 |
| Family | $2,157.33 | $1,033.99 | $1,123.34 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $626.65 | $668.31 | ($41.66)* |
| Employee & Spouse | $1,308.31 | $932.82 | $375.49 |
| Employee & Children | $1,119.08 | $896.78 | $222.30 |
| Family | $1,703.51 | $1,033.99 | $669.52 |
* 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).
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $576.13 | $668.31 | ($92.18)* |
| Employee & Spouse | $1,202.82 | $932.82 | $270.00 |
| Employee & Children | $1,028.87 | $896.78 | $132.09 |
| Family | $1,566.17 | $1,033.99 | $532.18 |
* 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.
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $793.60 | $647.48 | $146.12 |
| Employee & Spouse | $1,656.86 | $911.99 | $744.87 |
| Employee & Children | $1,417.25 | $875.95 | $541.30 |
| Family | $2,157.33 | $1,013.16 | $1,144.17 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $626.65 | $647.48 | ($20.83)* |
| Employee & Spouse | $1,308.31 | $911.99 | $396.32 |
| Employee & Children | $1,119.08 | $875.95 | $243.13 |
| Family | $1,703.51 | $1,013.16 | $690.35 |
* 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).
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $576.13 | $647.48 | ($71.35)* |
| Employee & Spouse | $1,202.82 | $911.99 | $290.83 |
| Employee & Children | $1,028.87 | $875.95 | $152.92 |
| Family | $1,566.17 | $1,013.16 | $553.01 |
*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 | $793.60 | $626.65 | $166.95 |
| Employee & Spouse | $1,656.86 | $891.16 | $765.70 |
| Employee & Children | $1,417.25 | $855.12 | $562.13 |
| Family | $2,157.33 | $992.33 | $1,165.00 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $626.65 | $626.65 | $0 |
| Employee & Spouse | $1,308.31 | $891.16 | $417.15 |
| Employee & Children | $1,119.08 | $855.12 | $263.96 |
| Family | $1,703.51 | $992.33 | $711.18 |
| Coverage | Total Premium | University Contribution | Employee Contribution |
|---|---|---|---|
| Employee Only | $576.13 | $626.65 | ($50.52)* |
| Employee & Spouse | $1,202.82 | $891.16 | $311.66 |
| Employee & Children | $1,028.87 | $855.12 | $173.75 |
| Family | $1,566.17 | $992.33 | $573.84 |
*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.