Faculty & Staff
Medical & Dental Premium Rates (Per Pay Period)
Effective 1/1/2013 - 12/31/2013
Blue Cross HMO Plus Option
|
|
Employee Contribution** |
SCU Contribution |
Total Per Pay Period* |
Monthly Cost* |
| Employee Only |
$13.03 |
$285.50 |
$298.53 |
$597.06 |
| EE + One Dependent |
$118.98 |
$505.55 |
$624.53 |
$1,249.06 |
| EE + Two or More Dependents |
$206.59 |
$687.50 |
$894.09 |
$1,788.17 |
| |
Blue Cross HMO Standard Option
|
|
Employee Contribution** |
SCU Contribution |
Total Per Pay Period* |
Monthly Cost* |
| Employee Only |
$7.37 |
$252.50 |
$259.87 |
$519.73 |
| EE + One Dependent |
$52.91 |
$490.45 |
$543.36 |
$1,086.72 |
| EE + Two or More Dependents |
$90.63 |
$687.50 |
$778.13 |
$1,556.25 |
| |
| Blue Cross PPO HSA (High Deductible Compatible) Medical |
|
Employee Contribution** |
SCU Contribution |
Total Per Pay Period* |
Monthly Cost* |
| Employee Only |
$58.43 |
$307.50 |
$365.93 |
$731.85 |
| EE + One Dependent |
$198.87 |
$557.26 |
$756.13 |
$1,512.26 |
| EE + Two or More Dependents |
$315.68 |
$765.00 |
$1,080.68 |
$2,161.35 |
| |
| Blue Cross PPO (HIA) Medical |
|
Employee Contribution** |
SCU Contribution |
Total Per Pay Period* |
Monthly Cost* |
| Employee Only |
$171.72 |
$307.50 |
$479.22 |
$958.43 |
| EE + One Dependent |
$445.58 |
$558.39 |
$1,003.97 |
$2,007.93 |
| EE + Two or More Dependents |
$671.12 |
$765.00 |
$1,436.12 |
$2,872.23 |
| |
Kaiser HMO Plus Option
|
|
Employee Contribution** |
SCU Contribution |
Total Per Pay Period* |
Monthly Cost* |
| Employee Only |
$17.22 |
$285.50 |
$302.72 |
$605.43 |
| EE + One Dependent |
$100.26 |
$505.17 |
$605.43 |
$1,210.86 |
| EE + Two or More Dependents |
$169.19 |
$687.50 |
$856.69 |
$1,713.37 |
| |
Kaiser HMO Standard Option
|
|
Employee Contribution** |
SCU Contribution |
Total Per Pay Period* |
Monthly Cost* |
| Employee Only |
$7.65 |
$285.51 |
$293.16 |
$586.31 |
| EE + One Dependent |
$81.13 |
$505.17 |
$586.30 |
$1,172.60 |
| EE + Two or More Dependents |
$142.12 |
$687.50 |
$829.62 |
$1,659.23 |
| |
| Delta Dental |
|
Employee Contribution** |
SCU Contribution |
Total Per Pay Period* |
Monthly Cost* |
| Employee Only |
$0.00 |
$38.67 |
$38.67 |
$77.33 |
| EE + One Dependent |
$9.21 |
$53.08 |
$62.29 |
$124.58 |
| EE + Two or More Dependents |
$21.05 |
$71.63 |
$92.68 |
$185.35 |
| |
*All Blue Cross Medical Plan rates include rates for VSP vision benefit.
**All employees and dependent contributions are automatically payroll deducted on a pretax basis.
Faculty and staff who do not wish to have contributions deducted on a pretax basis must sign a waiver form available in Human Resources. If at any time, payroll deductions cannot be withheld automatically, those under withheld contributions will be placed into an arrears account and will automatically restart when pay resumes.
revised: 10/15/2012
