Indiana University Indiana University

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Salary: $150,000 - $199,999
Medical plan coverage level: Family

Calculate the deduction from your paycheck

Health Plan options
Monthly Employee Contribution
HDHP PPO & HSA
$250.64
PPO $500 Deductible
$665.93
PPO $900 Deductible
$519.34
IU Health Quality Partners
$554.03
Subtract $25 per month for an employee or spouse ($50 for both) who do not use tobacco.
PPO Dental
   Employee only
   Employee + child(ren)
   Employee + spouse
   Family
$  9.19
$16.53
$21.57
$31.45
Medical plan
Tobacco-free affidavit has been/will be completed by
PPO Dental
How often is employee paid
Estimated deduction (per pay period) $

This tool is for illustrative purposes only. It is NOT an enrollment worksheet, and no entries will be saved. The medical premium will be based on the actual medical plan selection, coverage category, salary level, and tobacco-affidavit.

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