Agmt 2010 San Leandro Management Organization SLMO

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2010 Dental Rates Level Citv Em to gee Em to ee $51.23 $0.00 2- a $98.81 $0.00 Famil $155.37 $0.00 2010 Bay Area/Sacramento Rates Benefit & Level City Em to ee Benefit & Level City Em lovee Blue Shield Access+l $495.07 $82.26 PERSselect 1 $454.93 $20.00 Blue Shield Access+2 $990.14 $164.51 PERSselect 2 $909.86 $40.00 Blue Shield Access+3+ $1,259.18 $241.88 PERSselect 3+ $1,154.82 $80.00 Blue Shield Net Value 1 $472.80 $27.55 PERScare 1 $569.01 $299.16 Blue Shield Net Value 2 $945.60 $55.10 PERScare 2 $1,138.02 $598.32 Blue Shield Net Value 3+ $1,201.28 $99.63 PERScare 3+ $1,451.42 $805.82 Kaiser CAl $512.56 $20.00 PERSchoice 1 $476.93 $31.81 Kaiser CA2 $1.025.12 $40.00 PERSchoice 2 $953.86 $63.62 Kaiser CA3+ $1,304.66 $80.00 PERSchoice 3+ $1,212.01 $110.71 2010 Other Northern CA Rates Benefit & Level Ci Em lovee Benefit & Level City Em lo~~ee Blue Shield 1 $495.75 $90.27 PERSselect 1 $424.68 $35.01 Blue Shield 2 $991.50 $180.54 PERSselect 2 $849.36 $70.02 Blue Shield 3+ $1,260.95 $262.70 PERSselect 3+ $1,076.16 $119.03 PERSchoice 1 $441.49 $50.92 PERScare 1 $511.45 $299.16 PERSchoice 2 $882.98 $101.84 PERScare 2 $1,022.90 $598.32 PERSchoice 3+ $1,119.88 $160.39 PERScare 3 $1,301.77 $805.82 Kaiser 1 $509.02 $30.47 Kaiser 2 $1,018.04 $60.94 Kaiser 3+ $1,295.45 $107.22 2010 Out-of--State Rates Benefit & Level Cit Em to ee Benefit & Level Cit Em loyee Kaiser 1 $497.53 $227.16 PERSchoice 1 $504.78 $74.80 Kaiser 2 $995.06 $454.32 PERSchoice 2 $1,009.56 $149.60 Kaiser 3+ $1,265.58 $618.61 PERSchoice 3+ $1,284.43 $222.48 In 2011, the 2010 medical and dental rates listed above will be further adjusted by 50% of the change, respectively, between the 2010/11 dental rates and the Ca1PERS 2010/11 Bay Area rates in each individual plan. 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 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. 2 SLMO final 2010