Page 5 - UPDATED - 8-1-24 Heritage School Benefit Guide
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Medical Option Rates


          Baylor Scott & White (BSW)









                                                  2024 Rate Information
                            Cost is per Employee plus each additional family Member.
                                  (do not calculate cost for more than 3 children).
                            Then, subtract $600 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   $297.12     23    $388.40      32    $459.47    41     $505.69    50    $693.68     59   $1,010.99
          15    $323.53     24    $388.40      33    $465.30    42     $514.62    51    $724.36     60   $1,054.11

          16    $333.63     25    $389.95      34    $471.51    43     $527.05    52    $758.15     61   $1,091.39
          17    $343.73     26    $397.72      35    $474.62    44     $542.59    53    $792.33     62   $1,115.86

          18    $354.61     27    $407.04      36    $477.73    45     $560.84    54    $829.23     63   $1,146.54
          19    $365.48     28    $422.19      37    $480.83    46     $582.59    55    $866.12   64+  $1,165.19
          20    $376.74     29    $434.62      38    $483.94    47     $607.06    56    $906.13

          21    $388.40     30    $440.83      39    $490.16    48     $635.03    57    $946.52
          22    $388.40     31    $450.15      40    $496.37    49     $662.60    58    $989.63


                               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   $342.96     23    $448.31      32    $530.36    41     $583.71    50    $800.69     59   $1,166.96
          15    $373.45     24    $448.31      33    $537.08    42     $594.02    51    $836.11     60   $1,216.73

          16    $385.10     25    $450.11      34    $544.25    43     $608.36    52    $875.11     61   $1,259.76
          17    $396.76     26    $459.07      35    $547.84    44     $626.30    53    $914.56     62   $1,288.01

          18    $409.31     27    $469.83      36    $551.43    45     $647.37    54    $957.15     63   $1,323.43
          19    $421.86     28    $487.32      37    $555.01    46     $672.47    55    $999.74   64+  $1,344.92

          20    $434.87     29    $501.66      38    $558.60    47     $700.72    56    $1,045.92
          21    $448.31     30    $508.84      39    $565.77    48     $732.99    57    $1,092.54

          22    $448.31     31    $519.60      40    $572.95    49     $764.83    58    $1,142.31

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