Ithaca College
2017 Individual Choice Rates
Medical Plans
Total Annual Premium
or Equivalent
Employee Only
IC's Annual
Contribution
Employee's Annual
Contribution
High Deductible Health Plan/Health Savings Account
$7,616.00
$6,944.00
$672.00
Employee & Spouse/GFQDP*
$14,699.00
$1,000.00
$2,664.00
$1,500.00
$13,210.00
$10,654.00
$20,330.00
$15,782.00
Open Access Point of Service II Plan
$8,286.00
$6,150.00
$16,473.00
$11,325.00
$2,556.00
$4,548.00
$1,500.00
$1,500.00
$2,136.00
$5,148.00
N/A
N/A
Employee & Children
$14,748.00
$9,756.00
$4,992.00
N/A
Employee & Family
$23,307.00
$16,611.00
$6,696.00
N/A
Employee & Children
Employee & Family
Employee Only
Employee & Spouse/GFQDP*
$12,035.00
College's
Contribution to
HSA*
* Only tax-dependent grandfathered qualified domestic partners are eligible for the employer's contribution to the HSA. Please see plan rules for eligibility.
Dental Plans
Employee Only
Employee & Spouse/GFQDP*
Employee & Children
Employee & Family
Employee Only
Employee & Spouse/GFQDP*
Employee & Children
Employee & Family
Total Annual Premium or
IC's Annual
Equivalent
Contribution
Dental - Legacy Prime
$382.00
$274.00
$711.00
$351.00
$803.00
$371.00
$1,014.00
$426.00
Dental - Ortho Advantage
$373.00
$265.00
$694.00
$334.00
$784.00
$352.00
$990.00
$402.00
Employee's Annual
Contribution
$108.00
$360.00
$432.00
$588.00
$108.00
$360.00
$432.00
$588.00
Vision & Hearing Care Plan
Employee Only
Employee & Spouse/GFQDP*
Employee & Children
Employee & Family
Total Annual Premium or
Equivalent
$77.97
$164.06
$127.65
$213.00
IC's Annual
Contribution
$37.29
$38.78
$38.25
$39.72
Employee's Annual
Contribution
$40.68
$125.28
$89.40
$173.28
Employee Basic Life Insurance Plan
Amount of
Coverage
$50,000.00**
Total Annual Premium or Equivalent
IC's Annual Contribution
Employee's Annual Contribution
$120.00
$120.00
$0.00
Supplemental Life Insurance Plan
Age
< 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
IC's Annual
Contribution
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Employee's Annual Premium Rate Per $20,000** Unit
$8.40
$8.40
$9.60
$14.40
$21.60
$36.00
$55.20
$93.60
$124.80
$196.80
$344.40
$494.40
**Coverage amounts are reduced by 35% at age 65; 60% at age 70; and 75% and age 75.
◦ Maximum amount of coverage is $500,000, but may not exceed 7 X your annual base salary. Proof of Evidence of Insurability may apply.
Dependent Life Insurance Plan
Total Annual Premium or
Equivalent
IC's Annual
Contribution
Employee's Annual
Contribution
Option 1 - (Spouse/GFQDP* = $5,000;
Children = $2,500)
$23.52
$0.00
$23.52
Option 2 - (Spouse/GFQDP* = $10,000;
Children = $4,000)
$44.52
$0.00
$44.52
Accidental Death & Dismemberment (AD&D) Insurance Plan
Basic
$50,000
Voluntary
Employee Only
Employee & Family
Annual Premium per
$50,000 Unit
$13.20
Annual Premium per
$20,000 Unit
$9.36
$13.68
IC's Annual
Contribution
$13.20
IC's Annual
Contribution
$0.00
$0.00
Employee's Annual
Contribution
$0.00
Employee's Annual
Contribution
$9.36
$13.68
◦ Maximum amount of coverage is $300,000, but may not exceed 10 X your annual base salary.
Long-term Disability Insurance Plan
60% Benefit with Pension
60% Benefit without Pension
IC's Annual Premium or
Equivalent
.31 per $100 of covered payroll
.24 per $100 of covered payroll
IC's Annual Contribution
Variable
Variable
Employee's Annual
Contribution
$0.00
$0.00
Saving Account Maximums (Includes the College’s Contribution)
Health Savings Account
Health Care
Flexible Spending Account
$3,400 - Individual Coverage
$6,750 - Family Coverage
$2,600
Dependent Care
Flexible Spending Account
$5,000 ($2,500 if you are married and you
and your spouse file separate tax returns)
*GFQDP refers to Grandfathered Qualified Domestic Partners. No new enrollments in QDP benefits allowed after January 1, 2015.
Ithaca College reserves the right to change the numbers or the formulas used to calculate rates.