Agmt 2013 San Leandro Management Organization SLMO

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Effective October I, 2013, the City will contribute the monthly amounts including the CaIPERS Medical Plan "employer minimum share" contribution, towards the election of medical and dental benefits in the plan, or the actual premiums, whichever is less: Monthly Premium Employee Medical Plan Coverage Level City Pays Pays Blue Shield Access+ Employee only $784.63 $610.44 $174.19 HMO Employee + 1 $1,569.26 $1,220.88 $348.38 Employee + 2 or more $2,040.04 $1,587.14 $452.90 Blue Shield NetValue* Employee only $670.21 $610.44 $59.77 HMO Employee + 1 $1,340.42 $1,220.88 $119.54 Employee + 2 or more $1,742.55 $1,587.14 $155.41 Kaiser(CA) HMO Employee only $668.63 $610.44 $58.19 Employee + 1 $1,337.26 $1,220.88 $116.38 Employee + 2 or more $1,738.44 $1,587.14 $151.30 PERS Choice- PPO Employee only $667.03 $610.44 $56.59 Employee + 1 $1,334.06 $1,220.88 $113.18 Employee + 2 or more $1,734.28 $1,587.14 $147.14 PERSCare- PPO Employee only $1,083.11 $610.44 $472.67 Employee+ 1 $2,166.22 $1,220.88 $945.34 Employee+ 2 or more $2,816.09 $1,587.14 $1,228.95 PERS Select- PPO** Employee only $487.20 $487.20 $0.00 Employee+ 1 $974.40 $974.40 $0.00 Employee+ 2 or more $1,266.72 $1,266.72 $0.00 PORAC - PPO Employee only $581.00 $581.00 $0.00 For members of the Police Employee + 1 $1,088.00 $1,088.00 $0.00 Officers'Research Association Employee+ 2 or more $1,382.00 $1,382.00 $0.00 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 2 SLMO final 2013 •