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Health Insurance Rates Effective September 1, 2016 – August 31, 2017

Full-Time Employees, Retiree, and Academic Graduate Student Employees

UT Select Total Monthly Premium Monthly Premium Sharing Monthly Out-of Pocket Cost

Subscriber Only

$598.14

$598.14

0.00

Subscriber and Spouse

$1,169.22

$911.69

$257.53

Subscriber and Child(ren)

$1,068.10

$798.76

$269.34

Subscriber and Family

$1,621.33

$1,114.18

$507.15


Part-Time Employees

UT Select Total Monthly Premium Monthly Premium Sharing Monthly Out-of Pocket Cost

Subscriber Only

$598.14

$299.07

$299.07

Subscriber and Spouse

$1,169.22

$455.85

$713.37

Subscriber and Child(ren)

$1,068.10

$399.38

$668.72

Subscriber and Family

$1,621.33

$557.09

$1,064.24

COBRA Premiums

Plan Subscriber Only Subscriber & Spouse Subscriber & Child(ren) Subscriber & Family

UT Select PPO (BCBS)

$605.96

$1,188.46

$1,085.32

$1,649.62

UT Select Dental (Delta)

$33.05

$62.74

$69.16

$98.33

UT Select Dental Plus (Delta)

$60.21

$114.35

$126.17

$179.76

DeltaCare DHMO

$9.07

$17.24

$19.05

$27.20
Superior Vision $6.02 $9.49 $9.71 $15.40
Superior Vision Plus $9.18 $14.36 $15.38 $21.73

Graduate Student Fellows & Research Affiliate Postdoctoral Fellows

Coverage Type UT Select Medical (BCBS) UT Select Dental (Delta) UT Select Dental Plus (Delta) DeltaCare USA Superior Vision Superior Vision Plus

Subscriber Only

$598.14

$32.40

$59.03

$8.89 $5.90 $9.00

Subscriber and Spouse

$1,169.22

$61.51

$112.11

$16.90 $9.30 $14.08

Subscriber and Child(ren)

$1,068.10

$67.80

$123.70

$18.68 $9.52 $15.08

Subscriber and Family

$1,621.33

$96.40

$176.24

$26.67 $15.10 $21.30

Surviving Dependents

Medical Insurance Spouse Only Children Only Family Only

UT Select PPO (BCBS)

$571.08

$469.96

$1,023.19

Dental Insurance Spouse Only Children Only Family Only

UT Select Delta Dental

$29.11

$35.40

$64.00

UT Select Delta Dental Plus $53.08 $64.67 $117.21
DeltaCare USA $8.01 $9.79 $17.78
Vision Insurance Spouse Only Children Only Family Only

Superior Vision

$5.90

$5.90

$9.52

Superior Vision Plus $9.00 $9.00 $15.08