Contributions

Premier PPO Plan	Select PPO Plan	Value PPO Plan
HMO Illinois	UniCare HMO	NRSA Post Doctoral Fellows
Leave of Absence	COBRA	Retirees

Premier PPO

Full Time	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	128	281	239	422
$42,000.01-$75,000	152	332	282	499
$75,000.01-$128,000	182	399	339	600
$128,000.01-$182-000	222	485	413	729
$182,000.01 and above	280	613	522	921
Part Time	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	308.50	675.50	575	1015.50
$42,000.01-$75,000	320.50	701	596.50	1054
$75,000.01-$128,000	335.50	734.50	625	1104.50
$128,000.01-$182-000	355.50	777.50	662	1169
$182,000.01 and above	384.50	841.50	716.50	1265

NOTE:
- Full Time status is defined as employees scheduled to work at least 35 hours per week or an 100% appointment.
- Part Time status is defined as employees scheduled to work at least 17.5 hours per week or at least a 50% appointment but less than 100%.
- For Academic Full-Time Faculty [e.g., Medical School Faculty] Contributions are based on an individual's total professional salary.
- Union employees should consult the current contract for premium rates.


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Select PPO

Full Time	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	26	58	49	87
$42,000.01-$75,000	48	104	89	157
$75,000.01-$128,000	76	166	142	250
$128,000.01-$182-000	111	243	207	366
$182,000.01 and above	165	361	307	543
Part Time	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	190.50	417	354.50	626.50
$42,000.01-$75,000	201.50	440	374.50	661.50
$75,000.01-$128,000	215.50	471	401	708
$128,000.01-$182-000	233	509.50	433.50	766
$182,000.01 and above	260	568.50	483.50	854.50


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Value PPO

Full Time	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	11	23	21	35
$42,000.01-$75,000	21	47	39	70
$75,000.01-$128,000	48	105	89	157
$128,000.01-$182-000	75	164	140	248
$182,000.01 and above	115	251	213	376
Part Time	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	162	354	301.50	532
$42,000.01-$75,000	167	366	310.50	549.50
$75,000.01-$128,000	180.50	395	335.50	593
$128,000.01-$182-000	194	424.50	361	638.50
$182,000.01 and above	214	468	397.50	702.50


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HMOs

HMO Illinois	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Full Time	102	239	208	298
Part Time	248	579	504	721.50
Unicare	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Full Time	118	274	243	347
Part Time	270	629	552	789

NOTE:
- Full Time status is defined as employees scheduled to work at least 35 hours per week or an 100% appointment.
- Part Time status is defined as employees scheduled to work at least 17.5 hours per week or at least a 50% appointment but less than 100%.
- Union employees should consult the current contract for premium rates.


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Leave of Absence

	You	You+Spouse	You+Child(ren)	You+Spouse+Child(ren)
Premier PPO	489	1,070	911	1,609
Select PPO	355	776	660	1,166
Value PPO	313	685	582	1,029
HMO Illinois	394	919	800	1,145
Unicare	422	984	861	1,231


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COBRA

	You	You+Spouse	You+Child(ren)	You+Spouse+Child(ren)
Premier PPO	498.78	1091.40	929.22	1641.18
Select PPO	362.10	791.52	673.20	1189.32
Value PPO	319.26	698.70	593.64	1049.58
HMO Illinois	401.88	937.38	816	1167.90
Unicare	430.44	1003.68	878.22	1255.62


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Retirees

	Premier PPO	HMO Illinois	Unicare
You under 65	489	394	422
You + Spouse under 65	1,070	919	984
You + Child(ren) under 65	911	800	861
You + Spouse + Child(ren) under 65	1,609	1,145	1,231
You over 65	385	400
You + Spouse over 65	770	812
You + Child(ren) over 65	847	861
You + Spouse + Child(ren) over 65	1,233	1,240
You over 65 + Spouse under 65	874	794
You under 65 + Spouse over 65	874	794
You over 65 + Spouse under 65 + Child(ren)	1,505	1,152
You under 65 + Spouse over 65 + Child(ren)	1,505	1,152


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NRSA Post Doctoral Fellows

Since NSRA recipients are not considered by the Internal Revenue Service (IRS) to be employees, employee related benefits are not generally available. However, the University has made its health, dental and vision insurance plans accessible to NRSA recipients. Single coverage has the monthly insurance premium paid by a combination of funds from the NRSA grant and from University funds. No premium amount is charged to the recipient. Family coverage has the monthly premium paid by a combination of funds from the NRSA grant, from University funds and from the NRSA recipient by payroll deduction. The deduction is on an after tax basis. The amount is the increment between the single and family related contributions normally made by University faculty and staff.

Premier PPO	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	0	153	111	294
$42,000.01-$75,000	0	180	130	347
$75,000.01-$128,000	0	217	157	418
$128,000.01-$182-000	0	263	191	507
$182,000.01 and above	0	333	242	641
Select PPO	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	0	32	23	61
$42,000.01-$75,000	0	56	41	109
$75,000.01-$128,000	0	90	66	174
$128,000.01-$182-000	0	132	96	255
$182,000.01 and above	0	196	142	378
Value PPO	You	You + spouse	You + child(ren)	You + spouse + child(ren)
Under $42,000	0	12	10	24
$42,000.01-$75,000	0	26	18	49
$75,000.01-$128,000	0	57	41	109
$128,000.01-$182-000	0	89	65	173
$182,000.01 and above	0	136	98	261
HMO Illinois	You	You + spouse	You + child(ren)	You + spouse + child(ren)
	0	137	106	196
Unicare HMO	You	You + spouse	You + child(ren)	You + spouse + child(ren)
	0	156	125	229


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Contributions