Healthcare Eligibility

  • For the first 90 days as a new hire or re-hire, coverage is limited to employee medical and prescription coverage only. You may purchase dependent medical coverage during this 90-day period for an additional cost. This 90-day period is satisfied once your cumulative period that you are actively working as an employee reaches 90 days. The time that you may have worked in a temporary capacity will be credited toward the 90-day requirement. The time when you are not actively working does not count toward the 90-day requirement. If you leave employment and later return following a break in service of more than 180 calendar days, then you will be required to satisfy a new 90-day waiting period for full eligibility again.

  • Employees/dependents will be required to include a copy of their medical card if they are electing to enroll in PEBTF prescription drug coverage without enrolling in PEBTF medical coverage.

  • Eligibility for supplemental benefits (vision, dental, and hearing) will begin the day immediately following the date you have worked 90 days of employment. The Office of Human Resources will notify you of your date of eligibility for these benefits and instructions on how to enroll.

  • You may elect to cover eligible dependents for the first 90 days of employment; however, this coverage will be subject to an additional biweekly cost, called the Dependent Buy-Up Cost. See Healthcare Costs below for additional cost information.

Healthcare Options

There are three health plan options to choose from:

  • Choice PPO provided by Aetna*
    • (*) If you elect to enroll in the Choice PPO Plan, you will be required to pay an additional biweekly cost called a "buy-up" cost. See Healthcare Costs below for the Choice PPO buy-up cost.
  • Basic PPO provided by Highmark
  • PEBTF Custom HMO [HMOs vary by residence]

To learn more about each specific plan, please visit the PEBTF website.

Healthcare Plan Costs: Full-Time AFSCME/SCUPA/SEIU hired before 8/1/2003

  • Health care contributions are deducted on a pre-tax, bi-weekly basis, except when retroactive health care contributions are required. Retroactive health care contributions will be deducted on a post-tax basis.

  • AFSCME/SEIU employees pay a healthcare contribution of 2.75 percent of his/her biweekly gross salary through payroll deductions, regardless of option chosen (i.e., Medical Only, Medical and Prescription, Supplemental Only, etc.) Biweekly gross salary excludes premium or supplemental payments such as overtime, shift differentials, higher class pay, etc.

  • SCUPA Employees pay a healthcare contribution of 2.5 percent of his/her biweekly gross salary through payroll deductions, regardless of option chosen (i.e., Medical Only, Medical and Prescription, Supplemental Only, etc.) Biweekly gross salary excludes premium or supplemental payments such as overtime, shift differentials, higher class pay, etc.

  • Employees are eligible for an Employee Contribution Waiver for participation in the Get Healthy Program. The PEBTF will provide new employees/enrollments with information on how to participate in the Get Healthy Program and a due date after your health plan enrollment has been processed. New enrollments who qualify for the Get Healthy waiver will have the waiver applied retroactive to their first day of enrollment.

    • AFSCME/SEIU: If you did not complete or participate in the PEBTF Get Healthy Wellness screening, your Health Care Contribution remains at 5.5 percent of your gross base pay. If you participated in the Get Healthy Program, you pay only 2.5 percent. Please contact the PEBTF with any questions at (800) 522-7279
    • SCUPA: If you did not complete or participate in the PEBTF Get Healthy Wellness screening, your Health Care Contribution remains at 5 percent of your gross base pay. If you participated in the Get Healthy Program, you pay only 2.5 percent. Please contact the PEBTF with any questions at (800) 522-7279.
  • There is no additional cost to you, regardless of which plan you choose.

  • There is no deduction/cost if you waive health and supplemental benefits.

  • For a more personalized representation of all benefit costs, based on your salary and personal situation, we recommend using our cost calculator tools:

    • Part-time employees may contact the IUP Benefits Services Team at human-resources@iup.edu for a personalized representation of all benefits costs.

AFSCME/SEIU: CHOICE PPO (Single Coverage)

Provided by Aetna; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/ Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

SCUPA: CHOICE PPO (Single Coverage)

Provided by Aetna; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.5% 2.5% 2.5% 2.5% 2.5% 2.5%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5% 5% 5% 5% 5% 5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/ Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross

AFSCME/SEIU: CHOICE PPO (Multi-Party Coverage)

Provided by Aetna; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

SCUPA: CHOICE PPO (Multi-Party Coverage)

Provided by Aetna; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary)
2.5% 2.5% 2.5% 2.5% 2.5% 2.5%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5% 5% 5% 5% 5% 5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross

 

AFSCME/SEIU: BASIC PPO (Single Coverage)

Provided by Highmark; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant
2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

SCUPA: BASIC PPO (Single Coverage)

Provided by Highmark; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.5% 2.5% 2.5% 2.5% 2.5% 2.5%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5% 5% 5% 5% 5% 5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant
2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross

AFSCME/SEIU: BASIC PPO (Multi-Party Coverage)

Provided by Highmark; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

SCUPA: BASIC PPO (Multi-Party Coverage)

Provided by Highmark; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.5% 2.5% 2.5% 2.5% 2.5% 2.5%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5% 5% 5% 5% 5% 5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross

AFSCME/SEIU: PEBTF Custom HMO (Single Coverage)

Plan/network dependent on county of residence...see PEBTF website

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

SCUPA: PEBTF Custom HMO (Single Coverage)

Plan/network dependent on county of residence...see PEBTF website

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.5% 2.5% 2.5% 2.5% 2.5% 2.5%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5% 5% 5% 5% 5% 5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross

AFSCME/SEIU: PEBTF Custom HMO (Multi-Party Coverage)

Plan/network dependent on county of residence...see PEBTF website

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

SCUPA: PEBTF Custom HMO (Multi-Party Coverage)

Plan/network dependent on county of residence...see PEBTF website

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.5% 2.5% 2.5% 2.5% 2.5% 2.5%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5% 5% 5% 5% 5% 5%
Dependent Medical Buy-up Cost - - - - - -
Prescription Drug Plan Cost - - - - - -
Supplemental Plan Cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for a Get Healthy Participant 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross 2.5% BW Gross
Total Biweekly Cost for a Get Healthy Non-Participant 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross 5% BW Gross

Healthcare plan costs: Full-Time AFSCME/SCUPA/SEIU hired after 8/1/2003 for first 90 days

  • Health care contributions are deducted on a pre-tax, bi-weekly basis, except when retroactive health care contributions are required. Retroactive health care contributions will be deducted on a post-tax basis.
  • Employees pay a healthcare contribution of 2.75% of his/her biweekly gross salary through payroll deductions only if you elect to enroll in the PEBTF health plan coverage or you waive health care coverage and enroll only in the supplemental benefits (prescription, vision, dental, and hearing). Biweekly gross salary excludes premium or supplemental payments such as overtime, shift differentials, higher
  • Employees are eligible for an Employee Contribution Waiver for participation in the Get Healthy Program. The PEBTF will provide new employees/enrollments with information on how to participate in the Get Healthy Program and a due date after your health plan enrollment has been processed. New enrollments who qualify for the Get Healthy waiver will have the waiver applied retroactive to their first day of enrollment.
    • If you did not complete or participate in the PEBTF Get Healthy Wellness screening, your Health Care Contribution remains at 5.5 percent of your gross base pay. If you participated in the Get Healthy Program, you pay only 2.75 percent. Please contact the PEBTF with any questions at (800) 522-7279.
  • Full-time employees may elect the Choice PPO plan for an additional biweekly cost of $14.80 for single coverage and $38.17 for multi-party coverage. There is no additional cost for the Basic PPO or PEBTF Custom HMO plans.
  • Employees electing multi-party coverage will pay a biweekly "dependent buy-up" cost of $444.95 for the Choice PPO plan; $406.78 for the Basic PPO plan; or $423.85 for the PEBTF Custom HMO plan.
  • Employees may enroll in prescription drug coverage for a biweekly cost of $103.86 for single coverage and $257.67 for multi-party coverage.
  • Eligibility for vision, dental and hearing benefits begins with the employee's seventh month of employment.
  • There is no deduction/cost if you waive benefits.
  • For a more personalized representation of all benefit costs, based on your salary and personal situation, we recommend using our cost calculator tool.

CHOICE PPO: Provided by Aetna; Available to residents of all Pennsylvania counties
Single-Medical Only Single- Rx Only Single-Medical & Rx MultiParty- Medical Only MultiParty- Rx Only MultiParty-Medical & Rx
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Choice PPO Plan Buy-Up cost $20.42 - $20.42 $52.65 - $52.65
Dependent Medical Buy-Up cost - - - $462.35 - $462.35
Prescription Drug Plan cost - $103.86 $103.86 - $257.67 $257.67
Total Biweekly Cost for Get Healthy Participant
$20.42+ 2.75% BW Gross $103.86+ 2.75% BW Gross $124.28+ 2.75% BW Gross $515.00+ 2.75% BW Gross $257.67+ 2.75% BW Gross $772.67+ 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant $20.42+ 5.5% BW Gross $103.86+ 5.5% BW Gross $124.28+ 5.5% BW Gross $515.00+ 5.5% BW Gross $257.67+ 5.5% BW Gross $772.67+ 5.5% BW Gross

BASIC PPO: Provided by Highmark; Available to residents of all Pennsylvania Counties

Single-Medical Only Single- Rx Only Single- Medical &Rx MultiParty- Medical Only MultiParty- Rx Only MultiParty- Medical & Rx
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-Up cost - - - $409.70 - $409.70
Prescription Drug Plan cost - $103.86 $103.86 - $257.67 $257.67
Total Biweekly Cost for Get Healthy Participant
2.75% BW Gross $103.86+ 2.75% BW Gross $103.86+ 2.75% BW Gross $409.70+ 2.75% BW Gross $257.67+ 2.75% BW Gross $667.37+ 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant
5.5% BW Gross $103.86+ 5.5% BW Gross $103.86+ 5.5% BW Gross $409.70+ 5.5% BW Gross

$257.67+ 5.5% BW Gross

$667.67+ 5.5% BW Gross

PEBTF Custom HMO: Plan/network dependent on county of residence...see PEBTF website

Single-Medical Only Single- Rx Only Single-Medical&Rx MultiParty-Medical Only MultiParty- Rx Only MultiParty-Medical&Rx
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-Up cost - - - $435.28 - $435.28
Prescription Drug Plan cost - $103.86 $103.86 - $257.67 $257.67
Total Biweekly Costfor Get Healthy Participant 2.75% BW Gross $103.86+ 2.75% BW Gross $103.86+ 2.75% BW Gross $435.28+ 2.75% BW Gross $257.67+ 2.75% BW Gross $692.95+ 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant 5.5% BW Gross $103.86+ 5.5% BW Gross $103.86+ 5.5% BW Gross $435.28+ 5.5% BW Gross $257.67+ 5.5% BW Gross $692.95+ 5.5% BW Gross

Healthcare plan costs: Full-Time AFSCME/SCUPA/SEIU hired after 8/1/2003 starting after 90 days

  • Health care contributions are deducted on a pre-tax, bi-weekly basis, except when retroactive health care contributions are required. Retroactive health care contributions will be deducted on a post-tax basis.
  • Employees pay a healthcare contribution of 2.75 percent of his/her biweekly gross salary through payroll deductions only if you elect to enroll in the PEBTF health plan coverage or you waive health care coverage and enroll only in the supplemental benefits (prescription, vision, dental, and hearing). Biweekly gross salary excludes premium or supplemental payments such as overtime, shift differentials, higher class pay, etc.
  • Employees are eligible for an Employee Contribution Waiver for participation in the Get Healthy Program. The PEBTF will provide new employees/enrollments with information on how to participate in the Get Healthy Program and a due date after your health plan enrollment has been processed. New enrollments who qualify for the Get Healthy waiver will have the waiver applied retroactive to their first day of enrollment.
    • If you did not complete or participate in the PEBTF Get Healthy Wellness screening, your Health Care Contribution remains at 5.5 percent of your gross base pay. If you participated in the Get Healthy Program, you pay only 2.75 percent. Please contact the PEBTF with any questions at (800) 522-7279.
  • Employees may elect the Choice PPO plan for an additional biweekly cost of $20.42 for single coverage and $52.65 for multi-party coverage. There is no additional cost for the Basic PPO or PEBTF Custom HMO plans.
  • Employees may enroll in prescription drug coverage and supplemental coverage (vision/dental/hearing) at no additional cost.
  • There is no deduction/cost if you waive benefits.
  • For a more personalized representation of all benefit costs, based on your salary and personal situation, we recommend using our cost calculator tool.
    • Part-time employees may contact the IUP Benefits Services Team at human-resources@iup.edu for a personalized representation of all benefits costs.

CHOICE PPO (Single Coverage)

Provided by Aetna; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical&Rx Supplemental Only Medical& Supplemental Medical, Rx& Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75%

2.75% 2.75%

Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Choice PPO Plan Buy-Up cost $20.42 - $20.42 - $20.42 $20.42
Dependent Medical Buy-Up cost - - - - - -
Prescription Drug Plan cost - - - - - -
Supplemental Plan cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for Get Healthy Participant $20.42+ 2.75% BW Gross 2.75% BW Gross $20.42+ 2.75% BW Gross 2.75% BW Gross $20.42+ 2.75% BW Gross $20.42+ 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant $20.42+ 5.5% BW Gross 5.5% BW Gross $20.42+ 5.5% BW Gross 5.5% BW Gross $20.42+ 5.5% BW Gross $20.42+ 5.5% BW Gross

CHOICE PPO (Multi-party Coverage)

Provided by Aetna; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Choice PPO Plan Buy-Up cost $52.65 - $52.65 - $52.65 $52.65
Dependent Medical Buy-Up cost - - - - - -
Prescription Drug Plan cost - - - - - -
Supplemental Plan cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for Get Healthy Participant $52.65+ 2.75% BW Gross 2.75% BW Gross $52.65+ 2.75% BW Gross 2.75% BW Gross $52.65+ 2.75% BW Gross $52.65+ 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant $52.65+ 5.5% BW Gross 5.5% BW Gross $52.65+ 5.5% BW Gross 5.5% of BW Gross $52.65+ 5.5% BW Gross $52.65+ 5.5% BW Gross

BASIC PPO (Single Coverage)

Provided by Highmark; Available to residents of all Pennsylvania counties

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, Rx & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-Up cost - - - - - -
Prescription Drug Plan cost - - - - - -
Supplemental Plan cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant 5.5% BW Gross

5.5% BW Gross

5.5% BW Gross

5.5% BW Gross

5.5% BW Gross

5.5% BW Gross

BASIC PPO (MultiParty Coverage)

Provided by Highmark; Available to residents of all Pennsylvania counties

Medical Only Rx Only
Medical & Rx
Supplemental Only
Medical & Supplemental
Medical, Rx & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary)` 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-Up cost - - - - - -
Prescription Drug Plan cost - - - - - -
Supplemental Plan cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant
5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

PEBTF Custom HMO (Single Coverage)

Plan/network dependent on county of residence...see PEBTF website

Medical Only Rx Only Medical & Rx Supplemental Only Medical & Supplemental Medical, RX & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75% 2.75% 2.75% 2.75% 2.75% 2.75%
Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5% 5.5% 5.5% 5.5% 5.5% 5.5%
Dependent Medical Buy-Up cost - - - - - -
Prescription Drug Plan cost - - - - - -
Supplemental Plan cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross
Total Biweekly Cost for Get Healthy Non-Participant 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross 5.5% BW Gross

PEBTF Custom HMO (Multi-party Coverage)

Plan/network dependent on county of residence...see PEBTF website

Medical Only Rx Only Medical & Rx Supplemental Only Medical& Supplemental Medical, Rx, & Supplemental
Get Healthy Participant Employee Contribution (% of biweekly gross salary) 2.75%

2.75%

2.75%

2.75%

2.75%

2.75%

Get Healthy Non-Participant Employee Contribution (% of biweekly gross salary) 5.5%

5.5%

5.5%

5.5%

5.5% 5.5%
Dependent Medical Buy-Up cost - - - - - -
Prescription Drug Plan cost - - - - - -
Supplemental Plan cost (Dental/Vision/Hearing) - - - - - -
Total Biweekly Cost for Get Healthy Participant 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross 2.75% BW Gross

2.75% BW Gross 2.75% BW Gross

Total Biweekly Cost for Get Healthy Non-Participant 5.5% BW Gross

5.5% BW Gross 5.5% BW Gross

5.5% BW Gross

5.5% BW Gross 5.5% BW Gross