Health Insurance Rates

The following health insurances rates are Effective September 1, 2021 – August 31, 2022

UT Select Medical Insurance

Full-time Employees & All Retirees

Level

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

Subscriber Only

$628.06 $628.06 0.00

Subscriber and Spouse

$1,227.68 $957.26 $270.42

Subscriber and Child(ren)

$1,121.52 $838.70 $282.82

Subscriber and Family

$1,702.40 $1,169.88 $532.52

Part-time Employees

Level

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

Subscriber Only

$628.06 $314.02 $314.02

Subscriber and Spouse

$1,227.68 $478.64 $749.04

Subscriber and Child(ren)

$1,121.52 $419.36 $702.16

Subscriber and Family

$1,702.40 $584.94 $1,117.46

Graduate Student Fellows & Research Affiliate Postdoctoral Fellows

UT Select

Total Monthly Premium

Subscriber Only

$628.06

Subscriber and Spouse

$1,227.68

Subscriber and Child)ren

$1,121.52

Subscriber and Family

$1,702.40

Dental and Vision Insurance

Employees, Retirees, and Fellows

Level

UT Select Dental (Delta) UT Select Dental Plus (Delta) DeltaCare USA Superior Vision Superior Vision Plus

Subscriber Only

$28.52 $61.40 $8.80 $5.02 $7.64

Subscriber and Spouse

$54.14 $116.60 $16.74 $7.90 $11.98

Subscriber and Child(ren)

$59.66 $128.66 $18.50 $8.10 $12.82

Subscriber and Family

$84.84 $183.30 $26.40 $12.84 $18.10

Insurance Premiums for Surviving Dependents

Coverage Type

UT Select Medical (BCBS) UT Connect (DFW Area Only) UT Select Dental (Delta) UT Select Dental Plus (Delta) DeltaCare USA Superior Vision Superior Vision Plus

Spouse Only

$599.62 $572.58 $25.62 $55.20 $7.94 $5.02 $7.64

Child Only

$493.46 $465.18 $31.14 $67.26 $9.70 $5.02 $7.64

Spouse & Children

$1,074.34 $1,021.08 $56.32 $121.90 $17.60 $8.10 $12.82

COBRA Premiums

Plan

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

UT Select PPO (BCBS)

$636.48 $1,248.09 $1,139.81 $1,732.31

UT CONNECT Medical

 (DFW area only)

$636.48 $1220.51 $1,110.96 $1677.98

UT Select Dental (Delta)

$29.09 $55.22 $60.85 $86.54

UT Select Dental Plus (Delta)

$62.63 $118.93 $131.23 $186.97

DeltaCare DHMO

$8.98 $17.07 $18.87 $26.93

Superior Vision

$5.12 $8.06 $8.26 $13.10

Superior Vision Plus

$7.79 $12.22 $13.08 $18.46