2.1 PY 2024 DENTAL PLANS PREMIUM RATES_EXHIBIT A.PDF
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Dental Benefits – Premium Rates – Exhibit A
Plan Year 1/1/2024 to 12/31/2024
Monthly Premium Rates
Full-time Active Employees
Plan
Tier
Total Premium
Employer
Premium
Employee
Premium
Cigna (PPO) -
Self Insured
Employee
38.98
21.04
17.94
Employee + Spouse
85.82
46.34
39.48
Employee + Child(ren)
92.84
50.14
42.70
Employee + Family
119.18
64.36
54.82
Delta (PPO) -
Self Insured
Employee
40.48
18.06
22.42
Employee + Spouse
89.22
39.82
49.40
Employee + Child(ren)
96.52
43.04
53.48
Employee + Family
124.12
55.20
68.92
Cigna
(DHMO) –
Prepaid
Employee
9.70
4.96
4.74
Employee + Spouse
16.42
7.48
8.94
Employee + Child(ren)
22.76
11.12
11.64
Employee + Family
26.80
13.42
13.38
Part-time Active Employees
Plan
Tier
Total Premium
Employer
Premium
Employee
Premium
Cigna (PPO) -
Self Insured
Employee
38.98
10.52
28.46
Employee + Spouse
85.82
23.18
62.64
Employee + Child(ren)
92.84
25.08
67.76
Employee + Family
119.18
32.18
87.00
Delta (PPO) -
Self Insured
Employee
40.48
9.04
31.44
Employee + Spouse
89.22
19.90
69.32
Employee + Child(ren)
96.52
21.52
75.00
Employee + Family
124.12
27.60
96.52
Cigna
(DHMO) –
Prepaid
Employee
9.70
2.48
7.22
Employee + Spouse
16.42
3.74
12.68
Employee + Child(ren)
22.76
5.56
17.20
Employee + Family
26.80
6.72
20.08