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<br />SUNNYISLES <br />5395246 <br /> <br />City of Sunny Isles Beach <br /> <br />BENEFITS AND COST SUMMARY <br />FOR DENTAL PROPOSAL <br />Option 1.00 <br /> <br />Proposed Effective Date: March 01,2009 <br /> <br />PROPOSED SCHEDULE OF BENEFITS for Class 1 <br /> <br />Class 1: All Active Full-time Employees (Retired, temporary and seasonal employees are not eligible) <br /> <br />Minimum Hours: 30, unless otherwise agreed upon. <br />CALENDAR YEAR DEDUCTIBLE: <br /> <br />Deductible applies to: <br />INDIVIDUAL <br />FAMILY <br /> <br />In Network <br />Type II and III <br />$50 <br />$150 <br /> <br />Out of Network <br />Type II and III <br />$50 <br />$150 <br /> <br />BENEFITS LEVELS <br />PPO Plan <br />TYPE I - Diagnostic & Preventive <br />TYPE II - Basic Services <br />TYPE III - Major Services <br />TYPE IV - Orthodontia for Children <br />Out of Network - 90th percentile U & C <br /> <br />100% <br />95% <br />60% <br />60% <br /> <br />100% <br />80% <br />50% <br />50% <br /> <br />MAXIMUM BENEFIT per covered person: <br />TYPES I, II and III combined, per calendar year $1500 <br />TYPE IV, while covered by the plan $1000 <br />Maximum benefits will be reduced by amounts paid by prior plan. <br /> <br />$1500 <br />$1000 <br /> <br />BENEFIT WAITING PERIOD <br />TYPE II Expenses None <br />TYPE III Expenses 6 Months <br />TYPE IV Expenses 12 Months <br />Terms of the Prior Carrier Credit Provision may apply. <br /> <br />Waived For: <br /> <br />Current Participants <br />Current Participants <br /> <br />COST SUMMARY <br />Rates shown are monthly and are guaranteed for one year from the program effective date. <br />Eligible For PPO Plan <br />Employees with child ortho <br />84 $28.33 <br />12 $64.44 <br />28 $73.03 <br />29 $105.13 <br /> <br />Employee Only <br />Employee + Spouse <br />Employee + Child(ren) <br />Employee + Family <br /> <br />MONTHLY COST <br /> <br />$8,246.61 <br /> <br />The Lincoln National Life Insurance Company <br />4 <br /> <br />2/9/2009 <br />