Agmt 2009 San Leandro Management Organization SLMO

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2(1(19 Rav Area/Sacramento Rates Benefit & Level Cif Em to ee _ Bene~f & Level '. Cit = Em to ee Blue Shield 1 $478.31 $82.26 PERSselect 1 $433.16 $20.00 Blue Shield 2 $956.63 $164.51 PERSselect 2 $866.32 $40.00 Blue Shield 3+ $1,215.60 $241.88 PERSselect 3+ $1,098.22 $80.00 Blue Shield Net Value 1 $467.95 $27.55 PERScare 1 $480.37 $299.16 Blue Shield Net Value 2 $935.90 $55.10 PERScare 2 $960.74 $598.32 Blue Shield Net Value 3+ $1,188.67 $99.63 PERScare 3+ $1,220.96 $805.82 Kaiser 1 $488.30 $20.00 PERSchoice 1 $450.67 $31.81 Kaiser 2 $976.60 $40.00 PERSchoice 2 $901.34 $63.62 Kaiser 3+ $1,241.58 $80.00 PERSchoice 3+ $1,143.74 $110.71 2(1(14 Other Northern [~A Rates $enefit & L,e~'el Cit}_ Em to ee Beiaeiit & Level Cit Ern lu ec Blue Shield 1 $478.74 $90.27 PERSselect 1 $436.09 $35.01 Blue Shield 2 $957.48 $180.54 PERSselect 2 $872.18 $70.02 Blue Shield 3+ $1;216.73 $262.70 PERSselect 3+ $1,105.83 $119.03 PERSchoice 1 $450.67 $50.92 PERScare 1 $480.37 $299.16 PERSchoice 2 $901.34 $101.84 PERScare 2 $960.74 $598.32 PERSchoice 3+ $1,143.74 $160.39 PERScare 3 $1,220.96 $805.82 Kaiser 1 $489.15 $30.47 Kaiser 2 $978.30 $60.94 Kaiser 3+ $1,243.79 $107.22 2.M9 (lnt_nf-Ctate Rates Benefit & Level Cit ~ Em lo' ee Benefit & Level Cit ~ Employee Kaiser 1 $433.16 $227.16 PERSchoice 1 $450.67 $74.80 Kaiser 2 $866.32 $454.32 PERSchoice 2 $901.34 $149.60 Kaiser 3+ $1,098.22 $618.61 PERSchoice 3+ $1,143.74 $222.48 Employees who wish to waive enrollment in the medical and dental plans and who demonstrate to the satisfaction of the City their enrollment in another medical and dental plan, shall receive two-hundred dollars ($200.00) per month for their non-election of medical and dental benefits. In the event both spouses are employed by the City and eligible to enroll in the City's flex medical benefits plan, one employee may elect not to enroll in the medical and dental plans and will receive the two-hundred dollars ($200.00) per month payment, if enrolled under spouse's coverage. An employee may elect non-enrollment in the medical plan and enrollment in the dental plan and receive one hundred and fifty ($150.00) dollars per month for their non-election. An employee may elect to waive the dental plan only and enroll only in the medical plan and receive fifty dollars ($50.00) per month for their non-election. Re-enrollment in the medical and/or dental plan shall be allowed only based upon a qualifying event as defined by the IRS codes or during an open enrollment period. The parties agree that during the term of this agreement, they will jointly explore various instruments enabling employee savings for retiree medical costs and related purposes. 2 s1mo.09 final