2.1 FY 2020-21 DENTAL PLANS EXHIBIT A PREMIUM RATES.DOCX

Employee Benefits – Plan Year 2021 Premium Rates – Exhibit A
FY 2020-21 Dental
Full-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 38.26 20.66 17.60
Cigna (PPO) -
Employee + Spouse 84.24 45.52 38.72
Self Insured
Employee + Child(ren) 91.12 49.20 41.92
Employee + Family 116.98 63.08 53.90
Employee 44.02 19.64 24.38
Delta (PPO) -
Employee + Spouse 97.00 43.30 53.70
Fully Insured
Employee + Child(ren) 104.94 46.78 58.16
Employee + Family 134.94 60.00 74.94
Employee 9.26 4.52 4.74
Cigna
(DHMO) – Employee + Spouse 15.66 6.72 8.94
Prepaid Employee + Child(ren) 21.68 10.04 11.64
Employee + Family 25.52 12.14 13.38
Part-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 38.26 10.34 27.92
Cigna (PPO) - Employee + Spouse 84.24 22.76 61.48
Self Insured Employee + Child(ren) 91.12 24.60 66.52
Employee + Family 116.98 31.54 85.44
Employee 44.02 9.82 34.20
Delta (PPO) - Employee + Spouse 97.00 21.66 75.34
Fully Insured Employee + Child(ren) 104.94 23.40 81.54
Employee + Family 134.94 30.00 104.94
Employee 9.26 2.26 7.00
Cigna
Employee + Spouse 15.66 3.36 12.30
(DHMO) –
Prepaid Employee + Child(ren) 21.68 5.02 16.66
Employee + Family 25.52 6.08 19.44