Page 5 - 8-1-2025 Heritage School Benefit Guide

Medical Option Rates

Baylor Scott & White (BSW)

8-1-2025 Rate Information
Cost is per Employee plus each additional family Member.
(do not calculate cost for more than 3 children).
Then, subtract $650 as your Defined Employer Contribution.

MEDICAL - Baylor Scott & White (BSW) Core Plan
Silver PPO 80 4250
BSW Plus PPO

Age Monthly Cost Age Monthly Cost Age Monthly Cost Age Monthly Cost Age Monthly Cost Age Monthly Cost
<15 $326.25 23 $426.48 32 $504.52 41 $555.27 50 $761.68 59 $1,110.11
15 $355.25 24 $426.48 33 $510.92 42 $565.08 51 $795.38 60 $1,157.45

16 $366.34 25 $428.18 34 $517.74 43 $578.73 52 $832.48 61 $1,198.40
17 $377.43 26 $436.71 35 $521.15 44 $595.79 53 $870.01 62 $1,225.26

18 $389.37 27 $446.95 36 $524.56 45 $615.83 54 $910.52 63 $1,258.95
19 $401.31 28 $463.58 37 $527.98 46 $639.71 55 $951.04 64+ $1,279.43
20 $413.68 29 $477.23 38 $531.39 47 $666.58 56 $994.97

21 $426.48 30 $484.05 39 $538.21 48 $697.29 57 $1,039.32
22 $426.48 31 $494.28 40 $545.04 49 $727.57 58 $1,086.66

MEDICAL - Baylor Scott & White (BSW) Buy-Up Plan
Gold PPO 80 1500
BSW Plus PPO

Age Monthly Cost Age Monthly Cost Age Monthly Cost Age Monthly Cost Age Monthly Cost Age Monthly Cost
<15 $375.86 23 $491.32 32 $581.24 41 $639.70 50 $877.50 59 $1,278.92
15 $409.27 24 $491.32 33 $588.61 42 $651.00 51 $916.32 60 $1,333.45

16 $422.05 25 $493.29 34 $596.47 43 $666.73 52 $959.06 61 $1,380.62
17 $434.82 26 $503.12 35 $600.40 44 $686.38 53 $1,002.30 62 $1,411.57

18 $448.58 27 $514.91 36 $604.33 45 $709.47 54 $1,048.98 63 $1,450.39
19 $462.34 28 $534.07 37 $608.26 46 $736.99 55 $1,095.65 64+ $1,473.95

20 $476.58 29 $549.79 38 $612.19 47 $767.94 56 $1,146.26
21 $491.32 30 $557.65 39 $620.05 48 $803.31 57 $1,197.36

22 $491.32 31 $569.44 40 $627.91 49 $838.20 58 $1,251.89

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