| COVERAGE |
EMPLOYEE |
CITY |
TOTAL |
| HMO (Current) |
Health Maintenance Organization Plan |
| Employee |
19.04 |
361.85 |
380.89 |
| Employee +1 |
199.72 |
599.14 |
798.86 |
| Family |
277.41 |
832.22 |
1109.63 |
| PPO (Medical) |
|
| Employee |
156.96 |
525.47 |
682.43 |
| Employee +1 |
513.70 |
954.01 |
1467.71 |
| Family |
673.99 |
1251.69 |
1925.68 |
| DMO (Dental) |
Dental Maintenance Organization |
| Employee |
.00 |
11.94 |
11.94 |
| Employee +1 |
6.20 |
14.32 |
20.52 |
| Family |
17.60 |
12.80 |
30.40 |
| Dental (OA) |
Dental Open Access Advantage Plan |
| Employee |
4.42 |
11.94 |
16.36 |
| Employee +1 |
13.80 |
14.32 |
28.12 |
| Family |
28.86 |
12.80 |
41.66 |
| PPO (Dental) |
Dental Preferred Provider Organization |
| Employee |
23.20 |
11.94 |
35.14 |
| Two Member |
54.96 |
14.32 |
69.28 |
| Family |
108.00 |
12.80 |
120.80 |
| Vision |
Vision Care |
| Employee |
.00 |
4.48 |
4.48 |
| Family |
.00 |
12.80 |
12.80 |
| Life/AD&D |
Life/AD&D Insurance - 1 Time Salary |
|
.00 |
.26/$1000 |
.26/$1000 |
| Life/Additional |
Optional Life |
1, 2, or 3 Times |
Salary |
| Employee |
.35/$1000 |
.00 |
.35/$1000 |
| Life/Dependent |
Optional Dependent Life - Spouse/Child |
|
3.50 |
.00 |
3.50 |
| LTD |
Employee Long Term Disability |
| Employee |
.00 |
.49/$1000 Earnings |
.41%MIP |
