Agmt 2014 San Leandro City Employees Association SLCEA

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Monthly Premium Employee Medical Plan Coverage Level City Pays Pays 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 (option1) 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 2013 Dental Rates Level City Employee Employee $52.10 $.86 2-party $100.48 $1.66 Family $158.00 $2.61 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 electing not to enroll in the core flex benefit plan (i.e., who wish to waive enrollment in the medical and dental plans) and demonstrate to the satisfaction of the City their enrollment in another medical and dental plan, shall receive opt out premiums as set forth below. 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 employee opt-out rate if enrolled under spouse's medical and dental coverage. Employees may elect to opt out of the medical plan only, the dental plan only, or both. 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. 24