2.1 FY 2016-17 DENTAL PLANS EXHIBIT A PREMIUM RATES FINAL.DOC

Employee Benefits – Plan Year 2017 Premium Rates – Exhibit A
FY 2016-17 Dental
Full-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 33.54 18.60 14.94
Cigna (PPO) - Employee + Spouse 73.86 41.00 32.86
Self Insured Employee + Child(ren) 79.92 44.32 35.60
Employee + Family 102.58 56.80 45.78
Employee 42.50 18.60 23.90
Delta (PPO) - Employee + Spouse 93.66 41.00 52.66
Fully Insured Employee + Child(ren) 101.34 44.32 57.02
Employee + Family 130.26 56.80 73.46
Employee 8.32 3.76 4.56
Cigna
(DHMO) – Employee + Spouse 14.06 5.48 8.58
Prepaid Employee + Child(ren) 19.46 8.28 11.18
Employee + Family 22.92 10.04 12.88
Part-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 33.54 9.30 24.24
Employee + Spouse 73.86 20.50 53.36
Cigna (PPO) - Employee + Child(ren) 79.92 22.16 57.76
Self Insured Employee + Family 102.58 28.40 74.18
Employee 42.50 9.30 33.20
Employee + Spouse 93.66 20.50 73.16
Delta (PPO) - Employee + Child(ren) 101.34 22.16 79.18
Fully Insured Employee + Family 130.26 28.40 101.86
Employee 8.32 1.88 6.44
Cigna Employee + Spouse 14.06 2.74 11.32
(DHMO) – Employee + Child(ren) 19.46 4.14 15.32
Prepaid Employee + Family 22.92 5.02 17.90