FY 2022-23 DENTAL PLANS PREMIUM RATES ADJUSTED_EXHIBIT B.PDF
Extracted text (via pymupdf)
2208 characters
Dental Benefits – Premium Rates Adjusted – Exhibit B
FY 2022-23
Based on 26 Pay Periods
Full-time Active Employees
Plan
Tier
Pay Period
Total Premium
Pay Period
Employer
Premium
Pay Period
Employee
Premium
Cigna (PPO) -
Self Insured
Employee
17.99
9.71
8.28
Employee + Spouse
39.61
21.39
18.22
Employee + Child(ren)
42.85
23.14
19.71
Employee + Family
55.01
29.71
25.30
Delta (PPO) -
Self Insured
Employee
18.68
8.33
10.35
Employee + Spouse
41.18
18.38
22.80
Employee + Child(ren)
44.55
19.87
24.68
Employee + Family
57.29
25.48
31.81
Cigna
(DHMO) –
Prepaid
Employee
4.48
2.29
2.19
Employee + Spouse
7.58
3.45
4.13
Employee + Child(ren)
10.50
5.13
5.37
Employee + Family
12.37
6.19
6.18
Part-time Active Employees
Plan
Tier
Pay Period
Total Premium
Pay Period
Employer
Premium
Pay Period
Employee
Premium
Cigna (PPO) -
Self Insured
Employee
17.99
4.85
13.14
Employee + Spouse
39.61
10.70
28.91
Employee + Child(ren)
42.85
11.58
31.27
Employee + Family
55.01
14.86
40.15
Delta (PPO) -
Self Insured
Employee
18.68
4.17
14.51
Employee + Spouse
41.18
9.19
31.99
Employee + Child(ren)
44.55
9.93
34.62
Employee + Family
57.29
12.74
44.55
Cigna
(DHMO) –
Prepaid
Employee
4.48
1.15
3.33
Employee + Spouse
7.58
1.73
5.85
Employee + Child(ren)
10.50
2.56
7.94
Employee + Family
12.37
3.10
9.27