|
Pay |
12 Pay |
10 Pay |
|
Employee |
$0.00* |
$0.00* |
|
Spouse |
$383.04 |
$459.65 |
|
Children |
$240.67 |
$288.80 |
|
Family |
$552.52 |
$663.02 |
*75% to 100% FTE employee premium 100% funded by University; 50% to 74% FTE employees
employee premium 70% funded by University
Note: Base Plan costs listed above are net of University-provided subsidies listed
below.
|
Pay |
12 Pay |
10 Pay |
|
Employee |
$22-$90** |
$26.40-$108** |
|
Spouse |
$648.43*** |
$778.12*** |
|
Children |
$530.52*** |
$636.62*** |
|
Family |
$1120.00*** |
$1344.00*** |
**See below for employee contribution schedule. Employee between 50% and 74%, University
will fund 70% of premium
***Employee to pay dependent premium listed plus employee monthly contribution will
apply ($22.00 - $90.00 for 12 pay; $26.40-$108 for 10 pay)
|
Coverage |
12 Pay |
10 Pay |
|
Employee + Spouse |
$125.00 |
$150.00 |
|
Employee + Child(ren) |
$175.00 |
$210.00 |
|
*Family |
$325.00 |
$390.00 |
|
2015 W-2 Medicare wages |
12 Pay |
10 Pay |
|
< $27,000 |
$22.00 |
$26.40 |
|
$27,000 - $44,999 |
$45.00 |
$54.00 |
|
$45,000 - $69,999 |
$67.00 |
$80.40 |
|
$70,000 + |
$90.00 |
$108.00 |
Note: Employee contribution to employee premium based on Medicare wages, reported in Box 5 of the 2015 W-2 (Part time employees 75% and greater will have an annualized Medicare wage)
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