Medical Plan Rates

Part-time .5-.59 FTE, 9-month Appointed Active Employees

This is the amount that you will pay from each paycheck.

TIER 1 ($15,000 and Below)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$285.12	$689.72	$896.84	$1,123.47
BlueLincs HMO	$232.35	$571.85	$747.95	$940.46
BlueEdge HCA	$263.39	$648.41	$844.67	$1,059.35
Community Care HMO (Tulsa Area)	$261.63	$645.08	$840.45	$1,054.16
TIER 2 ($15,001 to $21,000)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$298.88	$700.22	$923.09	$1,168.47
BlueLincs HMO	$236.84	$582.35	$774.20	$985.46
BlueEdge HCA	$277.15	$658.91	$870.92	$1,104.35
Community Care HMO (Tulsa Area)	$275.39	$655.58	$866.70	$1,099.16
TIER 3 ($21,001 to $30,000)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$306.24	$724.97	$957.59	$1,213.47
BlueLincs HMO	$244.20	$607.10	$808.70	$1,030.46
BlueEdge HCA	$284.51	$683.66	$905.42	$1,149.35
Community Care HMO (Tulsa Area)	$282.75	$680.33	$901.20	$1,144.16
TIER 4 ($30,001 to $50,000)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$313.74	$733.22	$992.09	$1,258.47
BlueLincs HMO	$251.70	$615.35	$843.20	$1,075.46
BlueEdge HCA	$292.01	$691.91	$939.92	$1,194.35
Community Care HMO (Tulsa Area)	$290.25	$688.58	$935.70	$1,189.16
TIER 5 ($50,001 to $92,500)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$327.99	$740.72	$1,028.84	$1,303.47
BlueLincs HMO	$265.95	$622.85	$879.95	$1,120.46
BlueEdge HCA	$306.26	$699.41	$976.67	$1,239.35
Community Care HMO (Tulsa Area)	$304.50	$696.08	$972.45	$1,234.16
TIER 6 ($92,501 and Above)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$342.99	$746.72	$1,065.59	$1,340.97
BlueLincs HMO	$280.95	$628.85	$916.70	$1,157.96
BlueEdge HCA	$321.26	$705.41	$1,013.42	$1,276.85
Community Care HMO (Tulsa Area)	$319.50	$702.08	$1,009.20	$1,271.66