2.1 FY 2019-20 DENTAL PLANS EXHIBIT A PREMIUM RATES.DOCX

Employee Benefits – Plan Year 2020 Premium Rates – Exhibit A
FY 2019-20 Dental
Full-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 35.80 19.34 16.46
Cigna (PPO) -
Employee + Spouse 78.86 42.62 36.24
Self Insured
Employee + Child(ren) 85.30 46.06 39.24
Employee + Family 109.50 59.06 50.44
Employee 43.16 19.26 23.90
Delta (PPO) -
Employee + Spouse 95.10 42.44 52.66
Fully Insured
Employee + Child(ren) 102.88 45.86 57.02
Employee + Family 132.28 58.82 73.46
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 35.80 9.68 26.12
Cigna (PPO) - Employee + Spouse 78.86 21.32 57.54
Self Insured Employee + Child(ren) 85.30 23.04 62.26
Employee + Family 109.50 29.54 79.96
Employee 43.16 9.64 33.52
Delta (PPO) - Employee + Spouse 95.10 21.22 73.88
Fully Insured Employee + Child(ren) 102.88 22.94 79.94
Employee + Family 132.28 29.42 102.86
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