SDPOA Rate Sheet 2.pdf 1 5/19/2020 9:33:01 AM
SAN DIEGO
PEBA
*
FY21 FLEX BENEFIT RATE SHEET DENTAL
(Rates listed below are 24 cycle)
MetLife Dental HMO (0% increase)
MetLife Dental PPO
Delta Dental HMO
Delta Dental PPO
(0% increase)
(2.9% increase)
(2.95% increase)
EE Only
$10.50
$33.25
$5.86
$20.43
EE & Spouse/DP
$20.45
$62.25
$11.70
$40.82
EE & Child(ren)
$20.45
$71.50
$10.24
$39.81
EE & Family
$29.23
$104.25
$18.14
$63.08
SDPEBA VSP 2-Pair Plan
VISION
City VSP
LEGAL MetLife Legal
(6.9% - 7.1% decrease)
(Legal rates are 26 cycle) (0% increase)
(0% increase)
EE Only
$9.25
$2.35
$10.80
EE & Spouse/DP
$16.25
$4.70
$10.80
EE & Child(ren)
$16.25
$5.03
$10.80
EE & Family
$26.75
$8.04
$10.80
C
M
Y
CM
MY
CY
POA MEMBERS
- Flex Allotments Per Pay Period (24 Pay Periods)
1/2 Time (40 hours)
3/4 Time (60 hours)
Full Time (80 hours)
Waive
$158.44
$237.66
$316.88
EE Only
$207.13
$310.69
$414.25
EE & Spouse/DP
$258.02
$387.03
$516.04
EE & Child(ren)
$248.32
$372.47
$496.63
EE & Family
$347.92
$521.87
$695.83
CMY
K
LIEUTENANTS & CAPTAINS
- Flex Allotments Per Pay Period (24 Pay Periods)
1/2 Time (40 hours)
3/4 Time (60 hours)
Full Time (80 hours)
Waive
$220.94
$331.41
$441.88
EE Only
$269.63
$404.44
$441.88
EE & Spouse/DP
$320.52
$480.78
$641.04
EE & Child(ren)
$310.82
$466.22
$621.63
EE & Family
$410.42
$615.62
$820.83
*These rates may be adjusted when open enrollment starts due to rounding issues. The final rates published by the City of San Diego at the time of open enrollment supersede their rates. **Questions regarding City-sponsored plans (Kaiser and CIGNA) should be directed to RISK Management at 619-236-5924.