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Rates

Cigna HMO Low Plan w/Premium (DPPO) Dental Plan City provides stipend to each employee for health insurance. Employees may opt-out of health insurance by providing proof of alternate coverage. City pays 100% of the cost for employee coverage for dental DHMO plan and the vision plan and 50% of the cost for dependent coverage for dental DHMO plan and the vision plan. Dental and vision insurance are mandatory for employees. RATES

RATES PER MONTH

EMPLOYEE + CHILD(REN) $818.18 $82.86 $11.32

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

EMPLOYEE + SPOUSE

$650.00

$750.00

$750.00

$750.00

$500.00

$437.52

$818.18

$971.30

$1,238.19

$-

$26.29

$61.04

$70.14

$104.90

$-

$-

$2.54

$2.82

$5.50

$-

$463.81

$881.76

$1,044.26

$1,348.59

$-

$186.19

$(131.76)

$(294.26)

$(598.59)

$500.00

FICA / Medicare Tax (7.65%)

$14.24

0

0

0

$38.25

Monthly Balance (Subtotal less FICA/Medicare Tax)

171.95

131.76

294.26

598.59

461.75

Pay Period Balance (Cost or Allowance to Employee)

85.97

65.88

147.13

299.30

230.88

Health Insurance Dental Insurance Vision Insurance

EMPLOYEE $437.52 $39.72 $5.68 EMPLOYEE

Monthly City Insurance Stipend to Employee Monthly Cost Health Insurance Monthly Cost Dental Insurance Monthly Cost Vision Insurance Total Monthly Cost of Insurance

$971.30 $90.29 $10.76

FAMILY $1,238.19 $135.92 $16.68 FAMILY

OPTED OUT

Monthly Subtotal (insurance stipend less insurance cost)

*Note: Amounts in BLUE represent monies paid to employee; Amounts in RED represent monies paid by employee. **Pay period balance is based on 24 paychecks; therefore employees will have two paychecks with NO insurance deductions. 14


cigna-hmo-low-plan-w-premium-dental