Santa Clara University

Human Resorces

2015 Premium Rates

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Faculty & Staff
Medical & Dental Premium Rates (Per Pay Period)
Effective 1/1/2015 - 12/31/2015

Blue Cross HMO MEDICAL - Silver Option

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $16.08 $330.00 $346.08 $692.15
EE + One Dependent $104.91 $621.89 $726.80 $1,453.60
EE + Two or More Dependents $177.59 $860.73 $1,038.32 $2,076.63
 
Blue Cross HMO MEDICAL - Gold Option

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $69.61 $330.00 $399.61 $799.22
EE + One Dependent $217.30 $621.89 $839.19 $1,678.37
EE + Two or More Dependents $338.13 $860.73 $1,198.86 $2,397.71
 
Blue Cross PPO (High Deductible HSA) MEDICAL

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $48.40 $330.00 $378.40 $756.80
EE + One Dependent $166.10 $620.89 $786.99 $1,573.98
EE + Two or More Dependents $263.14 $860.73 $1,123.87 $2,247.73
 
Blue Cross PPO (HIA) Medical

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $173.83 $330.00 $503.83 $1,007.66
EE + One Dependent $436.14 $621.89 $1,058.03 $2,116.05
EE + Two or More Dependents $650.77 $860.72 $1,511.49 $3,022.98
 
KAISER HEALTH PLAN - Silver Option

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $3.20 $291.64 $294.92 $589.84
EE + One Dependent $43.55 $546.28 $589.83 $1,179.66
EE + Two or More Dependents $76.98 $757.64 $834.62 $1,669.23
 
KAISER HEALTH PLAN - Gold Option

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $12.90 $291.64 $304.54 $609.07
EE + One Dependent $62.78 $546.29 $609.07 $1,218.13
EE + Two or More Dependents $104.19 $757.64 $861.83 $1,723.65
 
Delta Dental

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $0.00 $38.58 $38.58 $77.16
EE + One Dependent $9.21 $52.94 $62.15 $124.30
EE + Two or More Dependents $21.05 $71.42 $92.47 $184.94
 
Blue View Vision

Employee Contribution** SCU Contribution Total Per Pay Period* Monthly Cost*
Employee Only $0.95 $2.37 $3.32 $6.64
EE + One Dependent $1.23 $3.62 $4.85 $9.69
EE + Two or More Dependents $1.90 $6.70 $8.60 $17.20

 

**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: 10/28/2014

See Also

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