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2014 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) $882.06 $88.83 $11.32

EMPLOYEE + SPOUSE

EMPLOYEE + CHILD(REN)

EMPLOYEE + SPOUSE

$700.00

$800.00

$800.00

$800.00

$471.69

$882.06

$1,047.15

$1,334.87

$

-

$28.67

$67.01

$75.56

$113.06

$

-

$2.82

$2.54

$5.50

$

-

$500.36

$951.89

$1,125.25

$1,453.43

$

-

$199.64

$(151.89)

$(325.25)

$(653.43)

$550.00

FICA / Medicare Tax (7.65%)

$15.27

0

0

0

$42.08

Monthly Balance (Subtotal less FICA/Medicare Tax)

184.37

151.89

325.25

653.43

507.93

Pay Period Balance (Cost or Allowance to Employee)

92.18

75.95

162.63

326.72

253.96

Health Insurance Dental Insurance Vision Insurance

EMPLOYEE $471.69 $42.10 $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

$

-

$1047.15 $95.71 $10.76

FAMILY $1,334.87 $144.08 $16.68 FAMILY

OPTED OUT

$550.00

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


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