The following health insurances rates are Effective September 1, 2020 – August 31, 2021
Full-Time Employees, Retirees, and Academic Graduate Student Employees
|
UT Select |
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 |
|
UT CONNECT (DFW area only) |
Total Monthly Premium | Monthly Premium Sharing | Monthly Out-of Pocket Cost |
|
Subscriber Only |
$628.06 | $628.06 | 0.00 |
|
Subscriber and Spouse |
$1,200.64 | $957.26 | $243.38 |
|
Subscriber and Child(ren) |
$1,093.24 | $838.70 | $254.54 |
|
Subscriber and Family |
$1,649.14 | $1,169.88 | $479.26 |
Part-Time Employees
|
UT Select |
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 |
|
UT CONNECT (DFW area only) |
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
(FT/PT Employees, Retirees, Academic Graduate Student Employees, Graduate Student Fellows & Research Affiliate Postdoctoral 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 | $5.90 | $9.00 |
|
Subscriber and Spouse |
$54.14 | $116.60 | $16.74 | $9.30 | $14.08 |
|
Subscriber and Child(ren) |
$59.66 | $128.66 | $18.50 | $9.52 | $15.08 |
|
Subscriber and Family |
$84.84 | $183.30 | $26.40 | $15.10 | $21.30 |
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 | $5.90 | $9.00 |
|
Child Only |
$493.46 | $465.18 | $31.14 | $67.26 | $9.70 | $5.90 | $9.00 |
|
Spouse &Children |
$1,074.34 | $1,021.08 | $56.32 | $121.90 | $17.60 | $9.52 | $15.08 |
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 |
$6.02 | $9.49 | $9.71 | $15.40 |
|
Superior Vision Plus |
$9.18 | $14.36 | $15.38 | $21.73 |