Medical Plan Rates

Full-time .76-1.0 FTE, 9-month Appointed Active Employees

This is the amount that you will pay from each paycheck.
Amounts in parentheses ( ) are credited to your paycheck.

TIER 1 ($30,000 or Below)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$0.00	$295.97	$425.09	$564.72
BlueLincs HMO	($43.50)	$178.10	$276.20	$381.71
BlueEdge HCA	($21.74)	$254.66	$372.92	$500.60
Community Care HMO (Tulsa Area)	($23.49)	$251.33	$368.70	$495.41
TIER 2 ($30,001 to $41,999)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$27.53	$316.97	$477.59	$654.72
BlueLincs HMO	($34.52)	$199.10	$328.70	$471.71
BlueEdge HCA	$5.79	$275.66	$425.42	$590.60
Community Care HMO (Tulsa Area)	$4.04	$272.33	$421.20	$585.41
TIER 3 ($42,000 to $59,999)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$42.24	$366.47	$546.59	$744.72
BlueLincs HMO	($19.80)	$248.60	$397.70	$561.71
BlueEdge HCA	$20.51	$325.16	$494.42	$680.60
Community Care HMO (Tulsa Area)	$18.75	$321.83	$490.20	$675.41
TIER 4 ($60,000 to $99,999)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$57.24	$382.97	$615.59	$834.72
BlueLincs HMO	($4.80)	$265.10	$466.70	$651.71
BlueEdge HCA	$35.51	$341.66	$563.42	$770.60
Community Care HMO (Tulsa Area)	$33.75	$338.33	$559.20	$765.41
TIER 5 ($100,000 to $184,999)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$85.74	$397.97	$689.09	$924.72
BlueLincs HMO	$23.70	$280.10	$540.20	$741.71
BlueEdge HCA	$64.01	$356.66	$636.92	$860.60
Community Care HMO (Tulsa Area)	$62.25	$353.33	$632.70	$855.41
TIER 6 ($185,000 and Above)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$115.74	$409.97	$762.59	$999.72
BlueLincs HMO	$53.70	$292.10	$613.70	$816.71
BlueEdge HCA	$94.01	$368.66	$710.42	$935.60
Community Care HMO (Tulsa Area)	$92.25	$365.33	$706.20	$930.41