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200- I4enta1- 14tttes <br /> Level Gity ' liraplovee <br /> Employee 551.23 5040 <br /> 2- Pahl: 598,8-1- 5040 <br /> Ptonily $15547 1 50:00 <br /> 20- 1-0- I33ty -A ret#Saeraniertt o- Rattes <br /> Benefit - &bevel Gil iii I uiplocee Benefit -& -Level Gity lirnplevee <br /> 1 Shield -k ess S49 -5.07 58 PERSsele44. $4- 5493 S2t7:00 <br /> 131+e- Shieht- Acees.;• 3 5990 -14 &444. PI R3seles42 S909:I46 S44140 <br /> Rh+e- Shield Aceess •3+ S•1439rt8 S211.33 1 4. S-1 $3040 <br /> 13{arshield-A:4P/Plue -3 5172.80 527.55 RERS are 1 5 $299.16 <br /> Blt+e- Shiehl Net Value-2 S94i40 555.10 l ItS;are - 5 1.133412 S5 °8.32 <br /> I34ae- 14. hi+.IJ \at VaIuc' $1.201.28 $9963 1 . S+:-4 5.1,42 3845:82 <br /> Kn1•er CA4 $512.56 S204)0 PERSelmice 1 $4.74 -93 S :1491. <br /> Kiii 51.025.1 $40:00 PI :RS.h,, ao 2 595'.86 563:62 <br /> Kaistc-C-\3- 51.301.66 S8000 1 RSeheke4 51.21244 S444-74 <br /> 201 F - 4tl+er- No#lter n CA- Rtttes <br /> Benef + +l @ -I.yel GIB; gropIovee Benefit -dc- level Gity 6mpinyee <br /> Bhre4110e c1-1 5195.75 590:2+ RERSseltct 1 512.1.68 525:04 <br /> 131ae-,Shie144 5991.50 5430.54 W=RSseleet -2 5849.36 57002 <br /> 1440e4Lhiels1-3 S1 -240A3 $26 W,114Sseket 3+ S147644 $449:03 <br /> 1 -e-1 -5.444,49 s5" 121414Seare - $511.15 529944 <br /> 1 ci-3 5883498 5101.84 PEltSeere -3 $1,022. °0 ,C593732 <br /> 1.0.04.SElx+ic:«++ 54.4 - 19:88 51 lM 14&.+re - 51 30144 5805.82 <br /> 1' aiscr 1 5509.03 - $44-17 <br /> r wiser 2 51.011:01 56".91 <br /> Kaise+3+ 51.2 0:14-5 5.10732 <br /> 2040- Out -ot trite- 1rates <br /> Benefit -& - Level Gity 6ntph+yee Benefit -& -Level Glt+ tmplovee <br /> Kaiser-I- 549 522446 RkiRSeheiee -1 5- 501.78 $7 <br /> Kaiser 2 5995:06 54 -54-32 PCRScheic -e2 541 -009,e6 84.19:60 <br /> Kaiser 34. SI .26538 56418:6+ PERSchoic -e-3+ 5 1.281.43 5222.18 <br /> 2011 Basic Dental Rates <br /> Level Cily Emplovee <br /> Emplovee 552.51 $1.28 <br /> party $10128 52.47 <br /> Family 5159.26 53.88 <br /> 2011 13a\' Area- Rates . <br /> Benefit & Level C llr Emplovee Benefit & Level CiIv Emplovee <br /> bloc Shield Access +I 5544.16 5131.35 I'IERSsclect I $131.35 528.87 <br /> Blur Shield Access+ 2 51,088.32 5262.70 PIiILSselect 2 5262.71) 557.75 <br /> Blue Shield Access+ 3+ 51.386.82 5369.51 I'El(Sselect 3+ 5369 5I 5103.07 <br /> 131uc Shield Net Value 1 5513.25 567.99 PEItScare 1 5581.90 5312.05 <br /> Blue Shield Net Value 2 51,026.49 5135.99 PERSeare 2 51,163.81) 5624.10 <br /> Blue Shield Nei Value 3+ 51.306.44 5204.78 I'EILScarc 3+ 51,48494 5839.33 <br /> Kaiser CA 1 5530.78 538.21 PE1tSchoicc 1 $ 504.26 5 59.14 <br /> Kaiser CA 2 51,061.55 576.43 PEILSchnice 2 .5 1008.52 $ 118.28 <br /> Kaiser CA 3+ 51.352,02 5127.35 I'ERSchoice 3+ $ 1283.07 $ 181.77 <br /> PORAC 1 $ 485.50 $ 41.50 <br /> PORAC 2 5 906.50 $ 80.50 <br /> POLL AC 3 $ 1.122.50 5 13 1.50 <br /> SLMO final 2010 <br />