2.1 FY 2021-22 DENTAL PLANS EXHIBIT A PREMIUM RATES.DOCX

Employee Benefits – Plan Year 2022 Premium Rates – Exhibit A
FY 2021-22 Dental  
Full-time Active Employees
 Plan 
 Tier 
 Monthly Total 
Premium 
 Monthly 
Employer 
Premium 
 Monthly 
Employee 
Premium 
Employee
          38.98 
          21.04 
          17.94 
Employee + Spouse
          85.82 
          46.34 
          39.48 
Employee + Child(ren)
          92.84 
          50.14 
          42.70 
Cigna (PPO) - 
Self Insured
Employee + Family
         119.18 
          64.36 
          54.82 
Employee
          40.48 
          18.06 
          22.42 
Employee + Spouse
          89.22 
          39.82 
          49.40 
Employee + Child(ren)
          96.52 
          43.04 
          53.48 
Delta (PPO) - 
Self Insured
Employee + Family
         124.12 
          55.20 
          68.92 
Employee
9.26
4.52
4.74
Employee + Spouse
15.66
6.72
8.94
Employee + Child(ren)
21.68
10.04
11.64
Cigna 
(DHMO) – 
Prepaid
Employee + Family
25.52
12.14
13.38
Part-time Active Employees
 Plan 
 Tier 
 Monthly Total 
Premium 
 Monthly 
Employer 
Premium 
 Monthly 
Employee 
Premium 
Employee
          38.98 
          10.52 
          28.46 
Employee + Spouse
          85.82 
          23.18 
          62.64 
Employee + Child(ren)
          92.84 
          25.08 
          67.76 
Cigna (PPO) - 
Self Insured
Employee + Family
         119.18 
          32.18 
          87.00 
Employee
          40.48 
            9.04 
          31.44 
Employee + Spouse
          89.22 
          19.90 
          69.32 
Employee + Child(ren)
          96.52 
          21.52 
          75.00 
Delta (PPO) - 
Self Insured
Employee + Family
         124.12 
          27.60 
          96.52 
Employee
9.26
2.26
7.00
Employee + Spouse
15.66
3.36
12.30
Employee + Child(ren)
21.68
5.02
16.66
Cigna 
(DHMO) – 
Prepaid
Employee + Family
25.52
6.08
19.44