Office of Human Resources - Benefits Design & Management
Medical Benefits Premium Chart (10.1.09-9.30.10) | MAIN OPEN ENROLLMENT PAGE | MEDICAL MAIN
| MEDICAL NETWORKS: Aetna (EPO, PPO, HSA) |AmeriBen (EPO, PPO) | Cigna (EPO) | United Healthcare (EPO, PPO) | |||||||
Pay Period |
Monthly |
||||||
| PLANS | EMPLOYEE | HEALTHFUND HSA UNIVERSITY CONTRIBUTION |
EMPLOYEE | UNIVERSITY | TOTAL | COBRA | 35% COBRA thru 12.31.09* |
| EPO Plans—Aetna (Aetna Select—Open Access), AmeriBen, Cigna, United Healthcare (United Healthcare Select EPO) | |||||||
| EMPLOYEE | $ 18.00 | $39.00 | $484.00 | $523.00 | $533.46 | $186.71 | |
| EMP+ADULT | $ 44.77 | $97.00 | $1,013.00 | $1,110.00 | $1,132.20 | $396.27 | |
| EMP+CHILD | $36.46 | $79.00 | $967.00 | $1,046.00 | $1,066.92 | $ 373.42 | |
| FAMILY | $ 82.15 | $178.00 | $1,264.00 | $ 1,442.00 | $1,470.84 | $ 514.79 | |
| PPO Plans—Aetna (Aetna Choice POS II—Open Access), AmeriBen, United Healthcare (United Healthcare Options PPO) | |||||||
| SINGLE | $ 71.08 | $154.00 | $641.00 | $795.00 | $810.90 | $ 283.82 | |
| EMP+ADULT | $151.38 | $328.00 | $1,318.00 | $1,646.00 | $1,678.92 | $587.62 | |
| EMP+CHILD | $142.62 | $309.00 | $1,268.00 | $1,577.00 | $1,608.54 | $562.99 | |
| FAMILY | $204.46 | $ 443.00 | $1,699.00 | $2,142.00 | $2,184.84 | $ 764.69 | |
| HSA OPTION PLAN with HealthFund HSA—AETNA CHOICE POS II | |||||||
| SINGLE | $11.54+ HealthFund Election |
$19.38 | $ 25.00+ HealthFund Election |
$444.00 +$42.00 HealthFund |
$469.00 +$42.00 HealthFund |
$478.38+ HealthFund Election |
$167.43+ HealthFund Election |
| EMP+ADULT | $36.92+ HealthFund Election |
$38.31 | $80.00+ HealthFund Election |
$906.00 +$83.00 HealthFund |
$986.00 +$83.00 HealthFund |
$1,005.72+ HealthFund Election |
$352.00+ HealthFund Election |
| EMP+CHILD | $27.23+ HealthFund Election |
$38.31 | $ 59.00+ HealthFund Election |
$879.00 +$83.00 HealthFund |
$938.00 +$83.00 HealthFund |
$956.76+ HealthFund Election |
$334.87+ HealthFund Election |
| FAMILY | $69.23+ HealthFund Election |
$38.31 | $150.00+ HealthFund Election |
$1,143.00 +$83.00 HealthFund |
$1,293.00 +$83.00 HealthFund |
$1,318.86+ HealthFund Election |
$461.60 + HealthFund Election |
| *If eligible for premium assistance | |||||||