Agmt 2013 San Leandro Police Management Unit SLPMU

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• Monthly Employee MetLife Dental .;: , :.;Coverage Level.. Premium: City,Pays ; Pays Basic Plan Employee only $52.96 $52.96 $0 Employee + 1 $102.14 $102.14 $0 Employee + 2 or more $160.61 $160.61 $0 Buy-up Plan (option 1) Employee only $27.38 $0.00 $27.38 Employee + 1 $55.23 $0.00 $55.23 Employee + 2 or more $101.63 $0.00 $101.63 • Buy-up Plan (option 2) Employee only $23.61 $0.00 $23.61 Employee + 1 $48.55 $0.00 $48.55 Employee + 2 or more $90.50 $0.00 $90.50 Sutter and Yuba counties Not available in Marin county In January 2014 and 2015, employees and City will each pay 50% of the increase or decrease in medical and dental premiums based on Kaiser and the Basic dental plan (i.e., 2014 premiums minus 2013 premiums, divided by 2 etc.). 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 will receive opt-out payments as follows: Employee rate: Medical $200 +/or dental $50= $250/month maximum Two-party rate: Medical $350 +/or dental $50= $400/month maximum Family rate: Medical $500 +/or dental $50= $550/month maximum In the event both spouses are employed by the City and eligible to enroll in the City's benefits plan, one employee may elect not to enroll in the medical and dental plans and will receive the single employee opt-out rate of up to two-hundred fifty dollars ($250.00) per month payment, if enrolled under spouse's medical and dental coverage. 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. SLPMU 3