2015 benefit premiums

Medical Plan Monthly Premiums


Medical Insurance (Base Plan)

Pay 12 Pay 10 Pay
Employee $0.00 $0.00*
Spouse $332.31 $398.77
Children $199.16 $238.99
Family $514.89 $617.87

Medical Insurance (Accelerated Plan)

Pay 12 Pay 10 Pay
Employee $22-$90 $26.40-$108
Spouse $572.01 $686.41**
Children $468.00 $561.60**
Family $988.01 $1185.61**

*Full-time employee premium 100% funded
**An additional employee monthly contribution will apply ($22.00 - $90.00 for 12 pay; $26.40-$108 for 10 pay)
Note: Base Plan costs are net of University-provided subsidies.

Monthly Dependent Medical Premium Supplement for Base Plan

Coverage 12 Pay 10 Pay
Employee + Spouse $125.00 $150.00
Employee + Child(ren) $175.00 $210.00
Family $275.00 $330.00

Monthly Employee Contribution Schedule for Accelerated Plan

2013 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

Dental Plan Monthly Premiums


Dental Insurance Plan A

Coverage 12 Pay 10 Pay
Employee $13.18 $15.82
Employee + Spouse $28.26 $33.91
Employee + Child(ren) $43.88 $52.66
Family $58.10 $69.72

Dental Insurance Plan B

Coverage 12 Pay 10 Pay
Employee $30.46 $36.55
Employee + Spouse $60.12 $72.14
Employee + Child(ren) $76.22 $91.46
Family $109.80 $131.76

Vision Plan Monthly Premiums


Vision Insurance Plan A

Coverage 12 Pay 10 Pay
Employee $3.05 $3.66
Employee + Spouse $4.30 $5.16
Employee + Child(ren) $4.37 $5.24
Family $6.46 $7.75

Vision Insurance Plan B

Coverage 12 Pay 10 Pay
Employee $11.44 $13.73
Employee + Spouse $18.35 $22.02
Employee + Child(ren) $18.73 $22.48
Family $30.22 $36.26

2015 Cafeteria Plan Funding***

Base Plan: $62.50 monthly ($750.00 annually)
Can apply funding to: dependent medical premiums, health savings account (HSA), medical reimbursement account (MRA), vision and dental premiums, and/or dependent care assistance.

Accelerated Plan: $20.83 monthly ($250.00 annually)
Can apply funding to: employee's portion of medical premium, dependent medical premiums, vision and dental premiums, medical reimbursement (MRA), and/or dependent care assistance.

***Prorated funding for part-time employees

The University reserves the right to modify or terminate such plans at any time with or without notice. Participation in these plans is provided to eligible employees and does not constitute a guarantee of employment. Participation is subject to the terms and conditions specified in the plan documents.

Contact

573.651.2206
Fax: 573.651.2108
humanresources@semo.edu
Academic Hall Room 012
Office of Human Resources
One University Plaza, MS 3150
Cape Girardeau, Missouri 63701