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Delta Dental Employee only $ 46.70 $ 48.15 $ - <br />Basic Plan Employee + 1 $ 88.70 $ 91.45 $ - <br /> Employee + 2 or more $ 138.30 $ 142.55 $ - <br /> Employee only $ 73.80 $ 48.15 $ 25.65 <br />Buy Up Plan 1 Employee + 1 $ 143.00 $ 91.45 $ 51.55 <br /> Employee + 2 or more $ 238.20 $ 142.55 $ 95.65 <br /> Employee only $ 67.20 $ 48.15 $ 19.05 <br />Buy Up Plan 2 Employee + 1 $ 131.80 $ 91.45 $ 40.35 <br /> Employee + 2 or more $ 218.60 $ 142.55 $ 76.05 <br />Vision Plan Coverage Level Monthly <br />Premium City Pays Employee <br />Pays <br />EyeMed Employee only $ 5.88 $ - $ 5.88 <br />Low Plan Employee + 1 $ 11.12 $ - $ 11.12 <br /> Employee + 2 or more $ 16.36 $ - $ 16.36 <br /> Employee only $ 11.28 $ - $ 11.28 <br />High Plan Employee + 1 $ 21.40 $ - $ 21.40 <br /> Employee + 2 or more $ 31.40 $ - $ 31.40 <br /> <br /> <br />For 2016, the monthly amounts above reflect an increase in the City’s contribution amount <br />as follows: <br />Employee only +$25 <br />Employee +1 +$50 <br />Employee +2 or more +$75 <br />In January 2017, 2018 and 2019, employees and City will each pay 50% of the increase or <br />decrease in medical and dental premiums based on Kaiser and the Basic dental plan (i.e., <br />2017 premiums minus 2016 premiums, divided by 2 etc.). <br /> <br />Employees who wish to waive enrollment in the medical and dental plans and who <br />demonstrate to the satisfaction of the City their enrollment in another medical and dental <br />plan will receive opt-out payments as follows: <br /> <br /> Employee rate: Medical $200 +/or dental $50 = $250/month maximum <br /> Two-party rate: Medical $350 +/or dental $50 = $400/month maximum <br /> Family rate: Medical $500 +/or dental $50 = $550/month maximum <br /> <br />In the event both spouses are employed by the City and eligible to enroll in the City’s <br />benefits plan, one employee may elect not to enroll in the medical and dental plans and will <br />receive the single employee opt-out rate of up to two-hundred fifty dollars ($250.00) per <br />month payment, if enrolled under spouse’s medical and dental coverage. <br /> <br />An employee may elect to waive the dental plan only and enroll only in the medical plan and <br />receive fifty dollars ($50.00) per month for their non-election. <br /> <br />Re-enrollment in the medical and/or dental plan shall be allowed only based upon a <br />qualifying event as defined by the IRS codes or during an open enrollment period. <br /> <br />SLPMA 3