|
Monthly Premiums for 2005-06 |
|
Faculty |
Composite Rate |
|
|
|
|
|
SISC PPO-A, Group #40303A |
|
|
|
|
$400
individual/$800 family Deductible |
|
$631 |
|
|
$20
Office Visits / 20% Co-insurance |
|
|
|
|
Medco
Rx $7 Generic /$25 Brand |
|
|
|
|
|
|
|
|
|
|
|
|
SISC PPO-B, Group #40303B |
|
|
|
|
$500
individual/$1000 family Deductible |
|
$598 |
|
|
$20
Office Visits / 20% Co-insurance |
|
|
|
|
Consumer
Share Rx $5/ $15/ $35 |
|
|
|
|
|
|
|
|
|
|
|
|
SISC PPO-C, Group #40303C |
|
|
|
|
$2,000
individual/$4000 family Deductible |
|
|
|
|
$30
Office Visits / 20% Co-insurance |
|
$474 |
|
|
Medco
Rx $200 Brand Name Deductible |
|
|
|
|
$10
Generic /$35 Brand |
|
|
|
|
|
|
|
|
|
|
|
|
SISC PPO-D, Group #40403D |
|
|
|
|
HSA
Compatible High Deductible Plan |
|
|
|
|
$1,200
individual/$2,400 family Deductible |
|
$513 |
|
|
Office
Visits Subject to ded., then 10% |
|
|
|
|
WellPoint
Rx subject to ded., then 10% |
|
|
|
| |
|
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|
|
Classified |
Single |
Double |
Family |
|
|
|
|
|
Blue
Shield PPO A Group #943189 |
|
|
|
|
$250
individual / $500 family Deductible |
|
|
|
|
$10
Office Visit / 10% Co-insurance |
$392.05 |
$729.06 |
$1138.55 |
|
Separate
$150 Brand Name Deductible |
|
|
|
|
Rx
$10 Generic /$20 Formulary/$35 Brand |
|
|
|
|
|
|
|
|
|
|
|
|
Blue
Shield PPO B Group #943190 |
|
|
|
|
$500
individual / $1000 family Deductible |
|
|
|
|
$25
Office Visits / 10% Co-insurance |
$330.67 |
$614.51 |
$960.22 |
|
Separate
$150 Brand Name Deductible |
|
|
|
|
Rx
$10 Generic /$20 Formulary/$35 Brand |
|
|
|
|
|
|
|
|
|
|
|
|
|
Blue
Shield PPO C
Group #944077 |
|
|
|
|
$2,250
individual/$4,500 family Deductible |
$239.29 |
$444.97 |
$694.92 |
|
Office
Visits 20% after deductible |
|
|
|
|
Rx
subject to deductible, then 20% |
|
|
|
|
|
|
|
|
Management |
Single |
Double |
Family |
|
|
|
|
|
Blue
Shield PPO A
Group #943189 |
|
|
|
|
$250
individual / $500 family Deductible |
|
|
|
|
$10
Office Visit / 10% Co-insurance |
$384.36 |
$714.76 |
$1116.23 |
|
Separate
$150 Brand Name Deductible |
|
|
|
|
Rx
$10 Generic /$20 Formulary/$35 Brand |
|
|
|
|
|
|
|
|
|
|
|
|
Blue
Shield PPO B Group
#943190 |
|
|
|
|
$500
individual / $1000 family Deductible |
|
|
|
|
$25
Office Visits / 10% Co-insurance |
$324.19 |
$602.79 |
$941.40 |
|
Separate
$150 Brand Name Deductible |
|
|
|
|
Rx
$10 Generic /$20 Formulary/$35 Brand |
|
|
|
|
|
|
|
|
|
|
|
|
|
Blue
Shield PPO C Group
#944077 |
|
|
|
|
$2,250
individual/$4,500 family Deductible |
$234.60 |
$436.24 |
$681.29 |
|
Office
Visits 20% after deductible |
|
|
|
|
Rx
subject to deductible, then 20% |
|
|
|
|
|
|
|
|
All
Staff |
Single |
Double |
Family |
|
|
|
|
|
Delta
Dental Group #6736-0001 |
|
|
|
|
$50
Deductible per person |
$41.90 |
$74.50 |
$108.04 |
|
Maximum
annual benefit $1,200 each |
|
|
|
|
|
|
|
|
|
|
|
|
Medical Eye Services - MES Vision |
$7.14 |
$14.18 |
$18.27 |
|
MES Group
# 03573 / Policy #
F21306 |
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