Agmt 2015 San Leandro Police Management Association SLPMA

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Montly Dental Plan Coverage Level Prem.hum City Pays Paysoyee Delta Dental Employee only $ 46.70 $ 48.15 $ - Basic Plan Employee + 1 $ 88.70 $ 91.45 $ - Employee+ 2 or more $ 138.30 $ 142.55 $ - Employee only $ 73.80 $ 48.15 $ 25.65 Buy Up Plan 1 Employee+ 1 $ 143.00 $ 91.45 $ 51.55 Employee+ 2 or more $ 238.20 $ 142.55 $ 95.65 Employee only $ 67.20 $ 48.15 $ 19.05 Buy Up Plan 2 Employee+ 1 $ 131.80 $ 91.45 $ 40.35 Employee+ 2 or more $ 218.60 $ 142.55 $ 76.05 MontVision Plan Coverage Level P emium City Pays Employee EyeMed Employee only $ 5.88 $ - $ 5.88 Low Plan Employee+ 1 $ 11.12 $ - $ 11.12 Employee+ 2 or more $ 16.36 $ - $ 16.36 Employee only $ 11.28 $ - $ 11.28 High Plan Employee+ 1 $ 21.40 $ - $ 21.40 Employee+ 2 or more $ 31.40 $ - $ 31.40 For 2016, the monthly amounts above reflect an increase in the City's contribution amount as follows: Employee only +$25 Employee +1 +$50 Employee +2 or more +$75 In January 2017, 2018 and 2019, 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., 2017 premiums minus 2016 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. SLPMA 15-19 3