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4 SLMO 2022 Memorandum of Understanding The City will continue to contribute the monthly amounts including the CalPERS Medical Plan “Minimum Employer Contribution”, towards the election of medical and dental benefits in the plan, or the actual premiums, whichever is less. As of January 1, 2022, these monthly contribution amounts are: Coverage Level City Pays Medical Employee only $ 742.01 Employee + 1 $1,484.00 Employee + 2 or more $1,939.22 Dental Employee only $ 48.95 Employee +1 $ 92.95 Employee +2 or more $144.90 Employees and City will each pay 50% of the increase in medical and dental premiums based upon Kaiser medical and the dental core plan (i.e., 2022 premiums minus 2021 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 group 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. No change in dental plan carrier, or level of benefits, shall be made unless agreed to by the Management Organization. 495