ATTACHMENT 1 – CITY SPONSORED PROGRAM PREMIUMS
Medical Plans Monthly Premium
Cigna Open Access (PPO)
Single $1,312.50
Two Party $2,763.57
Family $3,952.10
Cigna Full Network (HMO)
Single $1,027.11
Two Party $2,156.96
Family $3,081.38
Cigna Select Network (HMO)
Single $831.28
Two Party $1,745.71
Family $2,493.84
Cigna Minimum Value Plan
Single $840.01
Two Party $1,764.02
Family $2,520.05
Kaiser
Single $760.42
Two Party $1,520.83
Family $2,151.98
Dental Plans Monthly Premium
Delta Dental PPO
Single $51.14
Two Party $102.28
Family $127.85
ATTACHMENT 1 – CITY SPONSORED PROGRAM PREMIUM
Delta Dental HMO
Single $15.52
Two Party $31.03
Family $45.78
Vision Plans Monthly Premium
VSP
Single $7.99
Two Party $12.12
Family $22.15
The Standard - Basic Life/AD&D
Life rate per $1,000 $.09/covered lives
AD&D rate per $1,000 $.02/covered lives
The Standard - Long Term Disability
Rate per $100 of monthly payroll covered $.58/covered lives CIGNA Employee Assistance Program (EAP)
5 face to face visits $2.08/covered lives