Page 8 - University of the South-2022-Benefit Guide REVISED 3.30.22 FSA WAIT PERIOD

2022 BI-WEEKLY RATES

MEDICAL
PPO PLAN - OPTION 1

Salary Tier Employee Only Employee + Spouse Employee + Child(ren) Family
1 $14,820.00 - $19,999.00 $121.97 $243.95 $237.85 $365.92
2 $20,000.00 - $25,365.00 $123.26 $246.51 $240.35 $369.77
3 $25,366.00 - $39,999.00 $126.00 $251.99 $245.69 $377.99
4 $40,000.00 - $54,999.00 $131.59 $263.17 $256.59 $394.76
5 $55,000.00 - $69,999.00 $138.21 $276.42 $269.51 $414.62
6 $70,000.00 - $84,999.00 $147.79 $295.57 $288.18 $443.36

7 $85,000.00 - $124,999.00 $156.83 $313.66 $305.82 $470.48
8 $125,000.00 and above $165.16 $330.32 $322.06 $495.48
MEDICAL
HDHP PLAN - OPTION 2

Salary Tier Employee Only Employee + Spouse Employee + Child(ren) Family
1 $14,820.00 - $19,999.00 $54.56 $151.95 $148.15 $227.93
2 $20,000.00 - $25,365.00 $62.93 $154.64 $150.77 $231.96
3 $25,366.00 - $29,999.00 $78.72 $160.38 $156.37 $240.57
4 $30,000.00 - $39,999.00 $91.13 $182.25 $177.70 $273.38
5 $40,000.00 - $54,999.00 $97.78 $195.56 $190.67 $293.34

6 $55,000.00 - $69,999.00 $105.66 $211.33 $206.04 $316.99
7 $70,000.00 - $84,999.00 $117.07 $234.13 $228.28 $351.20
8 $85,000.00 - $124,999.00 $127.83 $255.66 $249.27 $383.49
9 $125,000.00 and above $137.75 $275.50 $268.61 $413.25

DENTAL
Salary Tier Employee Only Employee + Spouse Employee + Child(ren) Family
Not Applicable $13.16 $23.54 $24.27 $40.10

VISION

Salary Tier Employee Only Employee + Spouse Employee + Child(ren) Family
Not Applicable $3.49 $5.58 $5.70 $9.19 Family

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