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Premiums: Effective July 01, 2015

Medical

CORE MEDICAL PLAN Full-Time Monthly Faculty & StaffFull-Time Biweekly Faculty & StaffPart-Time Monthly Faculty & StaffPart-Time Biweekly Faculty & StaffCOBRA
Employee Only$156.77$72.36$517.40$238.80$527.75
Employee and Spouse or Domestic Partner$421.27$194.43$1,190.03$594.24$1,213.83
Employee and Child$274.74$126.80$776.11$358.20$791.63
Employee and Children$366.32$169.07$1,034.81$477.60$1,055.50
Family$531.17$245.15$1,500.47$692.53$1,530.48
VALUE MEDICAL PLANFull-Time Monthly Faculty & StaffFull-Time Biweekly Faculty & StaffPart-Time Monthly Faculty & StaffPart-Time Biweekly Faculty & StaffCOBRA
Employee Only$84.91$39.19$442.23$204.10$451.07
Employee and Spouse or Domestic Partner$246.14$113.60$1,017.12$469.44$1,037.46
Employee and Child$160.53$74.09$663.34$306.16$676.61
Employee and Children$214.04$98.79$884.45$408.21$902.14
Family$310.35$143.24$1,282.45$591.90$1,308.10

Dental

HIGH OPTION DENTAL PLANFull-Time Monthly Faculty & StaffFull-Time Biweekly Faculty & StaffPart-Time Monthly Faculty & StaffPart-Time Biweekly Faculty & StaffCOBRA
Employee Only$26.47$12.22$40.72$18.80$41.54
Employee and Spouse or Domestic Partner$55.11$25.44$84.79$39.13$86.48
Employee and Child$44.00$20.31$67.69$31.24$69.04
Employee and Children$57.05$26.33$87.77$40.51$89.53
Family$84.47$38.99$129.96$59.98$132.56
LOW OPTION DENTAL PLANFull-Time Monthly Faculty & StaffFull-Time Biweekly Faculty & StaffPart-Time Monthly Faculty & StaffPart-Time Biweekly Faculty & StaffCOBRA
Employee Only$14.82$6.84$22.80$10.52$23.26
Employee and Spouse or Domestic Partner$31.27$14.43$48.11$22.21$49.08
Employee and Child$25.19$11.63$38.76$17.89$39.53
Employee and Children$33.63$15.52$51.75$23.88$52.78
Family$48.16$22.23$74.09$34.20$75.57

Vision

VISION PLANFull & Part-Time
Monthly Faculty &
Staff
Full & Part-Time
Biweekly Faculty &
Staff
COBRA
Employee Only$6.18$2.85$6.30
Employee and 1 Dependent $11.96$5.52$12.20
Family$17.58$8.12$17.93

FSA

FLEXIBLE SPENDING ACCOUNTS - ANNUAL LIMITS
Health Care FSA (per employee limit)$2,550/ maximum per year
Dependent Care FSA (per household limit)$5,000/ maximum per year

Legal

Ultimate Advisor PlusUltimate Advisor
Full & Part-Time Monthly Faculty & Staff $23.00 $16.00
Full & Part-Time Biweekly Faculty & Staff $10.62 $7.39

Life Insurance

VOLUNTARY LIFE INSURANCE PLAN
AgeMonthly Biweekly
Rate per $1,000Rate per $1,000
Less than 25$0.06 $0.03
25 - 29$0.07 $0.03
30 - 34$0.09 $0.04
35 - 39$0.10 $0.05
40 - 44$0.11 $0.05
45 – 49$0.17 $0.08
50 - 54$0.25 $0.12
55 - 59$0.47 $0.22
60 - 64$0.73 $0.34
65 – 69$1.40 $0.65
70 – 74$2.27 $1.05
75 and over$3.40 $1.57
VOLUNTARY LIFE INSURANCE PLANBenefitMonthly PremiumBiweekly Premium
Option 1 - Spouse or Domestic Partner and Children$25,000/$10,000$5.25 $2.42
Option 2 - Spouse or Domestic Partner and Children$10,000/$5,000$2.25 $1.04
Option 3 - Spouse or Domestic Partner$25,000 $4.05 $1.87
Option 4 - Children$10,000 $1.20 $0.55
Option 5 - Spouse or Domestic Partner$10,000 $1.65 $0.76
Option 6 - Children$5,000 $0.60 $0.28

AFLAC

AFLAC - ACCIDENT PLANFull & Part-Time
Monthly Faculty & Staff
Full & Part-Time
Biweekly Faculty & Staff
Employee
Age 18-70
$17.68$8.16
Employee and Spouse or Domestic Partner
Age 18-70
$25.09$11.58
One-Parent Family
Age 18-70
$28.60$13.20
Two-Parent Family
Age 18-70
$37.31$17.22
AFLAC - SPECIFIED EVENT PLANFull & Part-Time
Monthly Faculty & Staff
Full & Part-Time Biweekly Faculty & Staff
Employee
Age 18-35
$11.70$5.40
Employee
Age 36-45
$18.86$8.70
Employee
Age 46-55
$25.35$11.70
Employee
Age 56-64
$32.89$15.18
One-Parent Family
Age 18-35
$12.87$5.94
One-Parent Family
Age 36-45
$19.63$9.06
One-Parent Family
Age 46-55
$26.13$12.06
One-Parent Family
Age 56-64
$33.80$15.60
Two-Parent Family
Age 18-35
$20.28$9.36
Two-Parent Family
Age 36-45
$33.54$15.48
Two-Parent Family
Age 46-55
$46.67$21.54
Two-Parent Family
Age 56-64
$63.96$29.52
Employee and Spouse or Domestic Partner
Age 18-35
$18.07$8.34
Employee and Spouse or Domestic Partner
Age 36-45
$30.94$14.28
Employee and Spouse or Domestic Partner
Age 46-55
$43.68$20.16
Employee and Spouse or Domestic Partner
Age 56-64
$60.32$27.84
AFLAC - CANCER PLANFull & Part-Time
Monthly Faculty & Staff
Full & Part-Time Biweekly Faculty & Staff
Employee
Age 18-75
$38.48$17.76
Employee and Spouse or Domestic Partner
Age 18-75
$68.64$31.68
One-Parent Family
Age 18-75
$38.48$17.76
Two-Parent Family
Age 18-75
$68.64$31.68

Retiree Information

Retiree on BCBS Medical (under age 65) Monthly Premiums
Retiree Only - Core Plan$430.40
Spouse Only - Core Plan$517.40
Retiree and Spouse - Core Plan$1,103.03
Retiree Only - Value Plan$355.23
Spouse Only - Value Plan$442.23
Retiree and Spouse - Value Plan$930.12
Retiree on BCBS and UHC
UHC Retiree, BCBS Core Spouse$660.23
UHC Retiree, BCBS Value Spouse$585.06
UHC Retiree, BCBS Core Spouse and Child$918.94
UHC Retiree, BCBS Value Spouse and Child$806.17
BCBS Core Retiree, UHC Spouse$573.23
BCBS Value Retiree, UHC Spouse$498.06
Retiree on UHC Medical (age 65 and over) Monthly Premiums
Retiree or Spouse Only $142.83
Retiree and Spouse $285.66
Retiree on AARP Medical (age 65 and over) Monthly Premiums
Outside of NCMonthly Rates Vary
Retiree Dental High Option Plan Monthly Premiums
Retiree or Spouse Only$40.72
Retiree and Spouse$84.79
Retiree Dental Low Option Plan Monthly Premiums
Retiree or Spouse Only$22.80
Retiree and Spouse$48.11
Retiree Vision Plan Monthly Premiums
Retiree or Spouse Only$6.18
Retiree and Spouse$11.96
Family$17.58