Employee Costs for Insurance Benefits
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1 Costs for Insurance Benefits Medical Plan... 2 Blue Choice PPO (Blue Cross/Blue Shield of Texas... 2 Dental Plans... 3 DR Dental... 3 QCD Red... 3 QCD White... 3 Other Insurances... 4 Accidental Death & Dismemberment (AD&D)... 4 AFLAC Policies... 5 Humana Cancer Long Term Care... 6 Supplemental Term Life...7-9
2 Medical Plan Blue Choice 2013 Monthly Medical Premium Schedule Faculty/Staff Contributions per *Annualized Salary Range 2013 Faculty/Staff Monthly Premiums per Annualized Salary Range Coverage Elections $33,700 or less $33,701- $46,200 $46,201- $58,700 $58,701- $71,100 $71,101- $83,600 $83,601 & over only $46 $105 $126 $151 $175 $ Children + Family $94 $209 $248 $301 $348 $365 $82 $182 $218 $268 $303 $319 $104 $221 $287 $354 $396 $412 *Annualized Salary for faculty/lecturers: The medical s for Faculty/Lecturers are calculated on annualized salary (1/10th of contracted salary X 12). Supplemental pay for teaching during the summer is not added to the benefit base. Explanation of How Medical Premiums are Determined 2
3 Dental Plans DR Dental Plan DR Dental Your Cost Monthly only One $ Family (more than one) $55.00 QCD Red Plan QCD Red Your Cost Monthly only One $ Family (more than one) $0.00 QCD White Plan QCD White Your Cost Monthly only One $ Family (more than one) $
4 Insurances Accidental Death & Dismemberment (AD&D) Plans $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 only 100% Plan A $ 0.88 $ 1.75 $ 2.63 $ 3.50 $ 4.38 $ 5.25 (100%) and (50%) Plan B $ 1.28 $ 2.55 $ 3.83 $ 5.10 $ 6.38 $ 7.65 (100%) and (100%) Plan C $ 1.68 $ 3.35 $ 5.03 $ 6.70 $ 8.38 $10.05 (100%) and Child (10%) Plan D $ 1.03 $ 2.05 $ 3.08 $ 4.10 $ 5.13 $ 6.15 (100%), (50%), and Child (10%) Plan E $ 1.43 $ 2.85 $ 4.28 $ 5.70 $ 7.13 $ 8.55 (100%), (100%), and Child (10%) Plan F $ 1.83 $ 3.65 $ $ 7.30 $ 9.13 $10.95 Plans $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 only 100% Plan A $ 6.13 $ 7.00 $ 7.88 $ 8.75 $ 9.63 $10.50 (100%) and (50%) Plan B $ 8.93 $10.20 $11.48 $12.75 $14.03 $15.30 (100%) and (100%) Plan C $11.73 $13.4 $15.08 $16.75 $18.43 $20.10 (100%) and Child (10%) Plan D $ 7.1 $ 8.20 $ 9.23 $10.25 $11.28 $12.30 (100%), (50%), and Child (10%) Plan E $ 9.98 $11.40 $12.83 $14.25 $15.68 $17.10 (100%), (100%), and Child (10%) Plan F $12.78 $14.60 $16.43 $18.25 $20.08 $
5 AFLAC Prepared for BAYLOR UNIVERSITY by Jamey Jaynes - FC975 with version 342,1 on 10/18/2012 American Family Life Assurance Company of Columbus (AFLAC) Texas Payroll Premium Rates are Monthly for Industry Class A ACCIDENT INDEMNITY LEVEL 2 - Premium Series A One-Parent Family & Two-Parent Family CANCER CARE PLAN CLASSIC Series A Individual Insured/ One-Parent Family Two-Parent Family CANCER CARE PLAN PREMIER Series A Individual Insured/ One-Parent Family Two-Parent Family HOSPITAL INTENSIVE CARE PROTECTION - Series A18400 Level 1 Individual Premium One parent family Insured/spouse , CRITICAL CARE AND RECOVERY (HEART/STROKE) Series A71100 Level 1 Two parent family Individual Premium One parent family Insured/spouse Two parent family CRITICAL CARE AND RECOVERY (HEART/STROKE) Series A71200 Level 2 Individual Premium One parent family Insured/spouse Two parent family SHORT-TERM DISABILITY Series A57600 Elimination Period Accident/Sickness 0/7 days Link to table. 5
6 Humana Cancer and Specified Disease Long Term Care Plans 1-4 Your Cost Based on plan, facility monthly benefit, facility benefit duration and age. Approved through underwriting. Contact Human Resources, , to receive a Long Term Care packet. 6
7 Supplemental Term Life Insurance Premium Calculation Table What am I eligible for: round your *basic annual salary to the nearest $25,000. Select a Plan: 1 time; 2 times; 3 times; 4 times; 5 times. Multiple your rounded salary by the plan selected. 25,000) $13,000 50,000) $25,000 75,000) $38,000 $100,000) $50,000 Your $25,000 $50,000 $75,000 $100,000 Under age
8 125,000) $63, ,000) $75, ,000) $88,000 Max. $200,000) $100,000 Your $125,000 $150,000 $175,000 $200,000 Under age $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 Your Under age
9 Your $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 Under age *Annualized Salary for faculty/lecturers: The s for Faculty/Lecturers are calculated on annualized salary (1/10th of contracted salary X 12). Supplemental pay for teaching during the summer is not added to the benefit base. Child(ren) Supplemental Term Life You may also elect to purchase Dependents' Term Life on your children). Should a child die for any reason while you are actively at work for Baylor University, benefits will be paid to you. Plan 1 Plan 2 Plan 3 Plan 4 Children: 0 days to age 6 months $2,500 $2,500 $2,500 $2,500 6 months to age 19 $2,500 $5,000 $7,500 $10,000 Students: 19 to age 26 $2,500 $5,000 $7,500 $10,000 Monthly Cost $.44 $.88 $1.32 $1.76 9
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