Full Water Service Restored at Southeast

Southeast Missouri State University

Medical Plan Monthly Premiums

Medical Insurance 12 (Base Plan*)

Pay Total Dependent**
Employee $401.68 $0.00
Employee + Spouse $843.52 $441.84
Employee + Child(ren) $763.19 $361.51
Family $1,164.86 $763.18

Medical Insurance 12 (Accelerated Plan***)

Pay Total Dependent
Employee $502.42 $0.00
Employee + Spouse $1,055.09 $552.67
Employee + Child(ren) $954.60 $452.18
Family $1,457.03 $954.61

Medical Insurance 10 (Base Plan*)

Pay Total Dependent**
Employee $482.02 $0.00
Employee + Spouse $1,012.22 $530.21
Employee + Child(ren) $915.83 $433.81
Family $1,397.83 $915.82

Medical Insurance 10 (Accelerated Plan***)

Pay Total Dependent
Employee $602.90 $0.00
Employee + Spouse $1,266.11 $663.20
Employee + Child(ren) $1,145.52 $542.62
Family $1,748.44 $1,145.53

*Full-time employee premium 100% funded

**Employee monthly contribution will apply ($22.00 - $90.00)

***Employee monthly contribution will apply to employee premium ($22.00-$90.00)

Monthly Dependent Medical Premium Supplement for Base Plan

Coverage 12 Pay 10 Pay
Employee + Spouse $125.00 $150.00
Employee + Child(ren) $150.00 $180.00
Family $250.00 $300.00

Monthly Employee Contribution for Accelerated Plan

2012 W-2 Medicare wages 12 Pay 10 Pay
< $27,000 $22.00 $26.40
$27,000 - $44,999 $45.00 $54.00
$45,000 - $69,999 $67.00 $80.40
$70,000 + $90.00 $108.00

Employee contribution based on 2010 calendar year reported Form
W-2 Medicare wage (box 5).

Dental Plan Monthly Premiums

Dental Insurance Plan A

Coverage 12 Pay 10 Pay
Employee $13.18 $15.82
Employee + Spouse $28.26 $33.91
Employee + Child(ren) $43.88 $52.66
Family $58.10 $69.72
Dental Insurance Plan B

Coverage 12 Pay 10 Pay
Employee $30.46 $36.55
Employee + Spouse $60.12 $72.14
Employee + Child(ren) $76.22 $91.46
Family $109.80 $131.76

Vision Plan Monthly Premiums

Vision Insurance Plan A

Coverage 12 Pay 10 Pay
Employee $3.05 $3.66
Employee + Spouse $4.30 $5.16
Employee + Child(ren) $4.37 $5.24
Family $6.46 $7.75
Vision Insurance Plan B

Coverage 12 Pay 10 Pay
Employee $11.44 $13.73
Employee + Spouse $18.35 $22.02
Employee + Child(ren) $18.73 $22.48
Family $30.22 $36.26

2014 Cafeteria Plan Funding***

Base Plan: $62.50 monthly ($750.00 annually)
Can apply funding to: dependent medical premiums, health savings account (HSA), medical reimbursement account (MRA), vision and dental premiums, and/or dependent care assistance.

Accelerated Plan: $20.83 monthly ($250.00 annually)
Can apply funding to: employee's portion of medical premium, dependent medical premiums, vision and dental premiums, medical reimbursement (MRA), and/or dependent care assistance.

***Prorated funding for part-time employees

The University reserves the right to modify or terminate such plans at any time with or without notice. Participation in these plans is provided to eligible employees and does not constitute a guarantee of employment. Participation is subject to the terms and conditions specified in the plan documents.

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