Page 5 - 2015 Saint Louis University Benefits Guide
P. 5
Saint Louis University
Medical/Prescription Drug
2015 Plan Payroll Deductions—No Changes!
Monthly Bi-Weekly
Coverage Type
Premium With Wellness Discount Premium With Wellness Discount
UHC Plus Plan
Employee (Ee) $143.79 $93.79 $66.36 $43.28
Ee/Spouse $386.97 $311.97 $178.60 $143.98
Ee/Child(ren) $332.25 $282.25 $153.35 $130.27
Family $520.66 $445.66 $240.30 $205.68
UHC Qualiied High Deductible Health Plan
Employee (Ee) $79.64 $29.64 $36.76 $13.68
Ee/Spouse $252.24 $177.24 $116.42 $81.80
Ee/Child(ren) $210.36 $160.36 $97.09 $74.01
Family $328.20 $253.20 $151.48 $116.86
UHC Plus Plan—Employees earning up to $33,000
Employee (Ee) $50 $0 $23.08 $0
Ee/Spouse $293.18 $218.18 $135.31 $100.70
Ee/Child(ren) $238.46 $188.46 $110.06 $86.98
Family $426.87 $351.87 $197.02 $162.40
Dental
2015 Plan Payroll Deductions—No Changes!
Monthly Bi-Weekly
Coverage Type
Flex Option New Basic Plus Option Flex Option New Basic Plus Option
Employee (Ee) $36.01 $21.07 $16.62 $9.72
Ee + 1 $70.49 $40.52 $32.53 $18.70
Family $120.69 $72.60 $55.70 $33.51
Vision
2015 Plan Payroll Deductions—New Coverage!
Coverage Type Monthly Bi-Weekly
Employee(Ee) $7.02 $3.24
Ee + Spouse $12.76 $5.89
Ee + Child(ren) $13.38 $6.18
Family $20.66 $9.54
Accident
2015 Plan Payroll Deductions—New Coverage!
Coverage Type Monthly Bi-Weekly
Employee(Ee) $24.74 $11.42
Ee + Spouse $41.90 $19.34
Ee + Child(ren) $39.62 $18.29
Family $56.78 $26.21
5
Medical/Prescription Drug
2015 Plan Payroll Deductions—No Changes!
Monthly Bi-Weekly
Coverage Type
Premium With Wellness Discount Premium With Wellness Discount
UHC Plus Plan
Employee (Ee) $143.79 $93.79 $66.36 $43.28
Ee/Spouse $386.97 $311.97 $178.60 $143.98
Ee/Child(ren) $332.25 $282.25 $153.35 $130.27
Family $520.66 $445.66 $240.30 $205.68
UHC Qualiied High Deductible Health Plan
Employee (Ee) $79.64 $29.64 $36.76 $13.68
Ee/Spouse $252.24 $177.24 $116.42 $81.80
Ee/Child(ren) $210.36 $160.36 $97.09 $74.01
Family $328.20 $253.20 $151.48 $116.86
UHC Plus Plan—Employees earning up to $33,000
Employee (Ee) $50 $0 $23.08 $0
Ee/Spouse $293.18 $218.18 $135.31 $100.70
Ee/Child(ren) $238.46 $188.46 $110.06 $86.98
Family $426.87 $351.87 $197.02 $162.40
Dental
2015 Plan Payroll Deductions—No Changes!
Monthly Bi-Weekly
Coverage Type
Flex Option New Basic Plus Option Flex Option New Basic Plus Option
Employee (Ee) $36.01 $21.07 $16.62 $9.72
Ee + 1 $70.49 $40.52 $32.53 $18.70
Family $120.69 $72.60 $55.70 $33.51
Vision
2015 Plan Payroll Deductions—New Coverage!
Coverage Type Monthly Bi-Weekly
Employee(Ee) $7.02 $3.24
Ee + Spouse $12.76 $5.89
Ee + Child(ren) $13.38 $6.18
Family $20.66 $9.54
Accident
2015 Plan Payroll Deductions—New Coverage!
Coverage Type Monthly Bi-Weekly
Employee(Ee) $24.74 $11.42
Ee + Spouse $41.90 $19.34
Ee + Child(ren) $39.62 $18.29
Family $56.78 $26.21
5
