Medical Plan Rates

Part-time .6-.75 FTE, Biweekly Active Employees

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

TIER 1 ($22,500 and Below)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$47.52	$164.28	$220.32	$281.37
BlueLincs HMO	$31.48	$124.99	$170.69	$220.36
BlueEdge HCA	$40.28	$150.51	$202.93	$259.99
Community Care HMO (Tulsa Area)	$39.69	$149.40	$201.53	$258.26

TIER 2 ($22,500.01 to $31,500)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$54.40	$169.53	$233.45	$303.87
BlueLincs HMO	$33.72	$130.24	$183.82	$242.86
BlueEdge HCA	$47.16	$155.76	$216.06	$282.49
Community Care HMO (Tulsa Area)	$46.57	$154.65	$214.65	$280.76

TIER 3 ($31,500.01 to $45,000)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$58.08	$181.91	$250.70	$326.37
BlueLincs HMO	$37.40	$142.62	$201.07	$265.36
BlueEdge HCA	$50.84	$168.14	$233.31	$304.99
Community Care HMO (Tulsa Area)	$50.25	$167.03	$231.90	$303.26

TIER 4 ($45,000.01 to $75,000)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$61.83	$186.03	$267.95	$348.87
BlueLincs HMO	$41.15	$146.74	$218.32	$287.86
BlueEdge HCA	$54.59	$172.26	$250.56	$327.49
Community Care HMO (Tulsa Area)	$54.00	$171.15	$249.15	$325.76

TIER 5 ($75,000.01 to $138,750)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$68.96	$189.78	$286.32	$371.37
BlueLincs HMO	$48.28	$150.49	$236.69	$310.36
BlueEdge HCA	$61.71	$176.01	$268.93	$349.99
Community Care HMO (Tulsa Area)	$61.13	$174.90	$267.53	$348.26

TIER 6 ($138,750.01 and Above)	EMPLOYEE ONLY	EMPLOYEE AND CHILD(REN)	EMPLOYEE AND SPOUSE	EMPLOYEE AND FAMILY
BlueChoice PPO	$76.46	$192.78	$304.70	$390.12
BlueLincs HMO	$55.78	$153.49	$255.07	$329.11
BlueEdge HCA	$69.21	$179.01	$287.31	$368.74
Community Care HMO (Tulsa Area)	$68.63	$177.90	$285.90	$367.01