2015 AGENDA ITEM EXHIBIT D DENTAL RATES 2_21_2014_VER3.DOCX

Exhibit D Employee Benefits – Plan Year 2015 Premium Rates
FY 2014-15 Dental Rates
Part-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 32.70 8.88 23.82
Cigna (PPO) - Employee + Spouse 72.04 19.58 52.46
Self Insured Employee + Child(ren) 77.94 21.18 56.76
Employee + Family 100.06 27.14 72.92
Employee 46.18 8.88 37.30
Delta (PPO) - Employee + Spouse 101.86 19.58 82.28
Fully Insured Employee + Child(ren) 110.14 21.18 88.96
Employee + Family 141.62 27.14 114.48
Employee 8.00 1.72 6.28
Cigna
(DHMO) – Employee + Spouse 13.50 2.46 11.04
Prepaid Employee + Child(ren) 18.74 3.78 14.96
Employee + Family 22.04 4.58 17.46