FY19 DENTAL BENEFITS EXHIBIT B NOV 13.DOCX

Employee Benefits – Plan Year 2019 Premium Rates – Exhibit B
FY 2018-19 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 59.05 50.45
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 8.98 4.24 4.74
Cigna
(DHMO) – Employee + Spouse 15.22 6.28 8.94
Prepaid Employee + Child(ren) 21.04 9.40 11.64
Employee + Family 24.78 11.38 13.40
Part-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 35.80 9.68 26.12
Employee + Spouse 78.86 21.32 57.54
Cigna (PPO) - Employee + Child(ren) 85.30 23.04 62.26
Self Insured Employee + Family 109.50 29.54 79.97
Employee 43.16 9.64 33.52
Employee + Spouse 95.10 21.22 73.88
Delta (PPO) - Employee + Child(ren) 102.88 22.94 79.94
Fully Insured Employee + Family 132.28 29.42 102.86
Employee 8.98 2.12 6.86
Cigna Employee + Spouse 15.22 3.14 12.08
(DHMO) – Employee + Child(ren) 21.04 4.70 16.34
Prepaid Employee + Family 24.78 5.70 19.08