Deluxe Plan Standard Plan Economy Plan
Deductible $100 per person $ 250 per person $500 per person
$300 per family $500 per family $1,500 per family
_____________________________________________________________________
Annual Out-of- $750 per person
$400 per person $3000 per person
pocket $1,250 per family
$750 per family $6,000 per family
Maximum Out-of-network Out-of-network
(does not charges do not charges do not
include accrue toward the accrue toward the
deductible) out-of-pocket out-of-pocket
maximum maximum
_____________________________________________________________________
Coinsurance 80% after In-network: 80% In-network: 80%
(the Percent deductibe after deductible after deductible
the Plan Pays)
for Most Out-of-network:
No Network Out-of-network:
Services 60% after
provisions 60% after
deductible deductible
_____________________________________________________________________
Lifetime
Maximum $2,000,000 $2,000,000 $2,000,000
_____________________________________________________________________
Hospital 100% first 90 days, In-network: 80% In-network: 80%
Admissions then 80% after after deductible after deductible
deductible
Out-of-network: Out-of-network:
60% after 60% after
deductible deductible
_____________________________________________________________________
Preventive Care Up to $400 per Up to $400 per Up to $400 per
person per year person per year person per year
toward preventive toward preventive toward preventive
related Medical related Medical related Medical
services, covered services, covered services, covered
at 100% with no at 100% with no at 100% with no
deductible deductible deductible
Includes annual Includes annual Includes annual
physical benefits physical benefits physical benefits
_____________________________________________________________________
All UA Choice plan benefits are subject to allowable changes.
Pharmacy Highlights
Deluxe Plan Standard Plan Economy Plan
Network 80% of generic $7 copay for $10 copay for generic
Pharmacy: 30 generic
day supply 80% of brand $20 copay for brand
(charges do not $10 copay for
apply to $500 annual brand $40 copay for non-
medical out-of- out-of-pocket perferred brand
pocket maximum
maximum)
_______________________________________________________________________
Home Delivery: 80% of generic $7 copay for $25 copay for generic
100 day supply generic
(charges do not 80% of brand $50 copay for brand
apply to medical $10 copay for
out-of-pocket $500 annual brand $100 copay for non-
maximum) out-of-pocket preferred brand
maximum
_______________________________________________________________________
Non-Network 80% after Pay retail price Pay retail price at time
Pharmacy medical at time of of purchase, submit
(charges do not deductible; pay purchase, submit claim form to be
apply to out-of- retail price at claim form to be reimbursed at
pocket time of purchase, reimbursed at negotiated price less
maximums) submit claim negotiated price appropriate copayment
form to be less appropriate
reimbursed at copayment
negotiated price
less the 20%
you pay
_______________________________________________________________________
All UA choice pharmacy benefits subject to negotiated price limits.
Dental Highlights
Deluxe Plan Standard Plan Economy Plan
Annual $2,000 $2,000 $2,000
Maximum
________________________________________________________________
Deductibles
Preventive $0 $0 $0
________________________________________________________________
Restorative $0 $25 $50
________________________________________________________________
Prosthetic $0 $25 (combined $50 (combined
with restorative) with restorative)
________________________________________________________________
Coinsurance
Preventive 100% 100% 80%
________________________________________________________________
Restorative 80% 80% 80%
________________________________________________________________
Prosthetic 50% 50% 50%
________________________________________________________________
Annual $2,000 $2,000 $2,000
Maximum
________________________________________________________________
Orthodontia 50% Not covered Not covered
$1500 lifetime
maximum
________________________________________________________________
Vision Highlights
Deluxe Plan Standard Plan Economy Plan
Copay No copay No copay No copay
____________________________________________________________________
Exam every 12 VSP network
months doctor:20% off VSP network VSP doctor:20%
the exam fee doctor:20% off off the exam fee
plus $100 the exam fee plus plus $100
allowence $100 allowence allowence
Non-VSP Non-VSP provider: Non-VSP provider:
provider: $100 $100 allowance $100 allowance
allowance
____________________________________________________________________
Lenses and
Frames or $125 allownce $50 allowence $50 allowence
contacts every
24 months
____________________________________________________________________
Discounts and When you go to a VSP network doctor, you will receive a 20%
Saveings discount off the doctor's fee for the exam in addition to your
allowence, up to 20% saving on lens extras (such as scratch
resistant and anti-reflective coatings and progressives), a 20%
discount when you purchase a complete pair of prescription
glasses and a 15 % discount off the cost of your contact lens
exam (fitting and evaluation). You will also save 20% off an
additional pair of prescription glasses, including prescription
sunglasses, from the same VSP network doctor within 12
months of your last eye exam. You will receive exclusive
pricing on annual supplies of certain brands of contacts. Finally,
although none of the plans provides coverage for laser eye
surgery, you can get a discount on laser vision correction
through a VSP network doctor.
___________________________________________________________________
UA CHOICE FY 08 RATES
26 Payrolls
Employee Bi- Dependent Bi Total Bi Weekly Annual Charge
Deluxe Plan (26 pay) Weekly Charge Weekly Charge Charge
Employee $51.74 N/A $51.74 $1,345
Employee + Spouse $51.74 $35.08 86.82 2,257
Employee + Child(ren) $51.74 $28.08 $79.82 $2,075
Employee + Family $51.74 $63.20 $114.94 $2,988
Employee Bi- Dependent Bi Total Bi Weekly Annual Charge
Standard Plan Weekly Charge Weekly Charge Charge
Employee $23.27 N/A $23.27 $605
Employee + Spouse $23.27 $6.62 $29.89 $777
Employee + Child(ren) $23.27 $5.31 $28.58 $743
Employee + Family $23.27 $11.89 $35.16 $914
Employee Bi- Dependent Bi Total Bi Weekly Annual Charge
Economy Plan Weekly Charge Weekly Charge Charge
Employee $3.00 N/A $3.00 $78
Employee + Spouse $3.00 $3.93 $6.93 $180
Employee + Child(ren) $3.00 $1.62 $4.62 $120
Employee + Family $3.00 $8.54 $11.54 $300
19 Payrolls
Employee Bi- Dependent Bi Total Bi Weekly Annual Charge
Deluxe Plan Weekly Charge Weekly Charge Charge
Employee $70.79 N/A $70.79 $1,345
Employee + Spouse $70.79 $48.00 $118.79 2,257
Employee + Child(ren) $70.79 $38.43 $109.22 $2,075
Employee + Family $70.79 $86.48 $157.27 $2,988
Employee Bi- Dependent Bi Total Bi Weekly Annual Charge
Standard Plan Weekly Charge Weekly Charge Charge
Employee $31.85 N/A $31.85 $605
Employee + Spouse $31.85 $9.06 $40.91 $777
Employee + Child(ren) $31.85 $7.27 $39.12 $743
Employee + Family $31.85 $16.27 $48.12 $914
Employee Bi- Dependent Bi Total Bi Weekly Annual Charge
Economy Plan Weekly Charge Weekly Charge Charge
Employee $4.11 N/A $4.11 $78
Employee + Spouse $4.11 $5.37 $9.49 $180
Employee + Child(ren) $4.11 $2.22 $6.33 $120
Employee + Family $4.11 $11.69 $15.80 $300
FY08 Bi-Weekly AD&D Rates
Employee Only Employee and Family
12-Month Employees 1.15 2.31
_______________________________________________________________________
9, 10, and 11-Month 1.58 3.16
Employees
_______________________________________________________________________
Bi-Weekly Supplemental Life Insurance Rates
Effective July 1, 2007
Rates for 12 month employees
Under 30 30 - 34 35 -39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64
$25,000 0.47 0.7 0.81 1.16 1.74 3 5.2 7.04
$50,000 0.93 1.39 1.62 2.31 3.47 6 10.39 14.08
$75,000 1.39 2.08 2.43 3.47 5.2 9 15.58 21.12
$100,000 1.85 2.77 3.24 4.62 6.93 12 20.77 28.16
$125,000 2.31 3.47 4.04 5.77 8.66 15 25.97 35.2
$150,000 2.77 4.16 4.85 6.93 10.39 18 31.16 42.24
$175,000 3.24 4.85 5.66 8.08 12.12 21 36.35 49.27
$200,000 3.7 5.54 6.47 9.24 13.85 24 41.54 56.31
$225,000 4.16 6.24 7.27 10.39 15.58 27 46.74 63.35
$250,000 4.62 6.93 8.08 11.54 17.31 30 51.93 70.39
$275,000 5.08 7.62 8.89 12.7 19.04 33 57.12 77.43
$300,000 5.54 8.31 9.7 13.85 20.77 36 62.31 84.87
$325,000 6 9 10.5 15 22.5 39 67.5 91.5
$350,000 6.47 9.7 11.31 16.16 24.24 42 72.7 98.54
$375,000 6.93 10.39 12.12 17.31 25.97 45 77.89 105.58
$400,000 7.39 11.08 12.93 18.47 27.7 48 83.08 112.62
Rates for 9, 10 and 11- month employees
Under 30 30 - 34 35 -39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64
$25,000 0.64 0.95 1.11 1.58 2.37 4.11 7.11 9.64
$50,000 1.27 1.9 2.22 3.16 4.74 8.22 14.22 19.27
$75,000 1.9 2.85 3.32 4.74 7.11 12.32 21.32 28.9
$100,000 2.53 3.79 4.43 6.32 9.48 16.43 28.43 38.53
$125,000 3.16 4.74 5.53 7.9 11.85 20.53 35.53 48.16
$150,000 3.79 5.69 6.64 9.48 14.22 24.64 42.64 57.79
$175,000 4.43 6.64 7.74 11.06 16.58 28.74 49.74 67.43
$200,000 5.06 7.58 8.85 12.64 18.95 32.85 56.85 77.06
$225,000 5.69 8.53 9.95 14.22 21.32 36.95 63.95 86.69
$250,000 6.32 9.48 11.06 15.79 23.69 41.06 71.06 96.32
$275,000 6.95 10.43 12.16 17.37 26.06 45.16 78.16 105.95
$300,000 7.58 11.37 13.27 18.95 28.43 49.27 85.27 115.58
$325,000 8.22 12.32 14.37 20.53 30.79 53.37 92.37 125.22
$350,000 8.85 13.27 15.48 22.11 33.16 57.48 99.48 134.85
$375,000 9.48 14.22 16.58 23.69 35.53 61.58 106.58 144.48
$400,000 10.11 15.16 17.69 25.27 37.9 65.69 113.69 154.11
65 +
15
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
65 +
20.53
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Important Contact Numbers
With questions about… Contact… Or Visit…
Medical or Dental Plans Blue Cross at www.premera.com
(800) 364 -2982
_________________________________________________________________________________________
Prescription Drugs PharmaCare at www.prharmacare.com/members
(800) 569 -2178
_________________________________________________________________________________________
Vision Plans VSP at www.vsp.com
(800) 877 -7195
_________________________________________________________________________________________
Flexible Spending Accounts Fringe Benefits www.fbmc-benefits.com
Management Company at
(800) 342 - 8017
_________________________________________________________________________________________
Employee Assistance ComPsych, the Guidance www.guidanceresorces.com
Program Resources Company
(866) 465 -8934 (enter University of Alaska ID:GC5901Q)
__________________________________________________________________________________________
Other Issues UAA Human Resources 786 -4608
Eligibility, UAF Human Resources 474 -7700
Enrollment process, GI Human Resources 474 -6010
Address Changes UAS Human Reosources 465 -6473
Life event channges, or Statewide Human 450 -8200
Life insurance Resources
_________________________________________________________________________________________