2.1 FY 2022-23 DENTAL PLANS PREMIUM RATES_EXHIBIT A.PDF
Extracted text (via pymupdf)
2195 characters
Dental Benefits – Premium Rates – Exhibit A
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
9.70
8.29
Employee + Spouse
39.61
21.40
18.21
Employee + Child(ren)
42.85
23.14
19.71
Employee + Family
55.01
29.70
25.31
Delta (PPO) -
Self Insured
Employee
18.68
8.32
10.36
Employee + Spouse
41.18
18.38
22.80
Employee + Child(ren)
44.55
19.86
24.69
Employee + Family
57.29
25.48
31.81
Cigna
(DHMO) –
Prepaid
Employee
4.48
2.30
2.18
Employee + Spouse
7.58
3.44
4.14
Employee + Child(ren)
10.50
5.12
5.38
Employee + Family
12.37
6.20
6.17
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
11.57
31.28
Employee + Family
55.01
14.85
40.16
Delta (PPO) -
Self Insured
Employee
18.68
4.16
14.52
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
1.72
5.86
Employee + Child(ren)
10.50
2.56
7.94
Employee + Family
12.37
3.10
9.27