UT Southwestern Medical Center
UT Select Medical Rates
September 1, 2015 - August 31, 2016
FULL-TIME
UT SELECT MEDICAL RATES
Coverage Level
Subscriber
Only
Subscriber
& Spouse
Subscriber
& Child(ren)
Subscriber
& Family
Total Monthly Premium Rates
$566.96
$1,108.27
$1,012.42
$1,536.81
$566.96
$864.17
$757.12
$1,056.10
$0.00
$244.10
$255.30
$480.71
Full-Time Premium Sharing
Paid by UT Southwestern
Full-Time Subscriber
Out-of-Pocket Cost
PART-TIME
UT SELECT MEDICAL RATES
Coverage Level
Subscriber
Only
Subscriber
& Spouse
Subscriber
& Child(ren)
Subscriber
& Family
Total Monthly Premium Rates
$566.96
$1,108.27
$1,012.42
$1,536.81
$283.48
$432.09
$378.56
$528.05
$283.48
$676.18
$633.86
$1,008.76
Part-Time Premium Sharing
Paid by UT Southwestern
Part-Time Subscriber
Out-of-Pocket Cost
Please see the Plan Certificates for UT Select located under the Insurance tab at www.utsystem.edu/offices/employee-benefits
for an expanded comparison and for Plan Limitations and Exclusions.
________________________________________________________________________________________
Questions? Please call 214-648-9830 or email Benefits@UTSouthwestern.edu
20150710