ensus MESSA Dental RateTOTALStroduct NameRate teriodt Ratet RateFF RateompositeTotal ostEstimated Annual SaingsSET SF ADN SET SF ADN Blue SF Dental ttO Blue SF Dental t ID: 895873
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1 Dental Rate SummarÇLakeÇood tuÄlic Sc
Dental Rate SummarÇLakeÇood tuÄlic SchoolsAll EmploÇeesAssumed EffectiÇe Date: ϱ/Ï/ϮϬϮÏ/urrent tlan;sÍ¿ and Segment:ÏtÏ®tFF/ompositeTotal Annual /ostRate teriod/ensusÏÏ°ÏÏϲϰ$ϵϳ.Ï°Ï® $ÏϬϰ,ϬϰϴÏ/Ï/ϮϬϮÏâÏÏ®/ϯÏ/ϮϬϮÏMESSA Dental: ϳϬ/ϳϬ/ϳϬ/ϳϬ; $ϮϬϬϬ/$ÏϬϬϬRate$ϯϮ.ϵϳ$ϲϮ.ϵϵ$ÏÏϳ.Ï°Ï°Administrators & NonâUnion Staf /ensusÏ®Ïϲ$Ïϯϴ.ϬϮ MESSA Dental: ϴϬ/ϴϬ/ϴϬ/ϴϬ; $ϮϬϬϬ/$ÏϯϬϬRate$Ï°Ï.ϯϵ$ϳϳ.Ï°Ï´$Ïϰϱ.ϱϵTOTALS:ÏÏ°ÏϯϴϬtroduct NameRate teriodÏt RateÏ®t RateFF Rate/ompositeTotal /ostEstimated Annual SaÇingsSET SF ADN: ϴϬ/ϴϬ/ϴϬ/ϴϬ; $ϮϬϬϬ/$ÏϯϬϬϳ/Ï/ϮϬϮÏâϲ/ϯϬ/ϮϬϮÏ$ϯϲ.ϳϰ$ϲϳ.Ïϯ$ÏϯϮ.Ϯϰ$ÏÏÏ.ϴϯ$Ïϰϯ,ϱϵϱSET SF ADN: ϳϬ/ϳϬ/ϳϬ/ϳϬ; $ϮϬϬϬ/$ÏϬϬϬϳ/Ï/ϮϬϮÏâϲ/ϯϬ/ϮϬϮÏ$ϯÏ.Ϯϲ$ϱϲ.Ïϳ$ÏϬϵ.ϱϰ$ϵϮ.Ï´ÏBlue SF Dental ttO: ϳϱ/ϳϬ/ϳϬ/ϳϬ; $ϮϬϬϬ/$ÏϬϬϬϱ/$
2 Ϯϳ.ϴϴ$ϱϱ.ϳϱ$ϵϳ.ϱϲ$ϴϯ.ϯϲB
Ϯϳ.Ï´Ï´$ϱϱ.ϳϱ$ϵϳ.ϱϲ$ϴϯ.ϯϲBlue SF Dental ttO:ϴϬ/ϴϬ/ϴϬ/ϴϬ; $ϮϬϬϬ/$ÏϱϬϬϱ/Ï/ϮϬϮÏâÏÏ®/ϯÏ/ϮϬϮϮ$ϯÏ.ϲϬ$ϲϯ.ϮϬ$ÏÏϬ.ϲϬ$ϵϰ.ϱϬGuardian*MESSA rates include taÇes and fees. *SETSEG SF/ADN rates are illustratiÇe and include a $ϲ.ϯϱ per emploÇee per month dental administration/netÇork fee. The plan includes access to the ADN/DentemaÇ netÇork.*SETSEG SF/ADN rates are Äased on enrollment and adÇance selfâfunded reserÇe is reÆuired. *B/BSM rates are illustratiÇe onlÇ and do not include agent commissions. Declined To QuoteDeclined To Quote Printed On 3/31/2021 Vision Rate SummarÇLakeÇood tuÄlic SchoolsAll EmploÇeesAssumed EffectiÇe Date: ϱ/Ï/ϮϬϮÏ/urrent tlan;sÍ¿ and Segment:ÏtÏ®tFF/ompositeTotal Annual /ostRate teriodAll EmploÇees/ensusÏÏ°ÏϯϴϬ$Ï®Ï.Ï¯Ï $Ϯϳ,ϯϱϳÏ/Ï/ϮϬϮÏâÏÏ®/ϯÏ/ϮϬϮÏVSt ϯ $Ϭ/$Ϭ /opaÇ: $ϲϱ FrameRate$ϳ.ϱÏ
3 µ$Ïϲ.ϯϬ$Ϯϰ.ϱϮTOTALS:ÏÏ°ÏϯϴϬ
µ$Ïϲ.ϯϬ$Ϯϰ.ϱϮTOTALS:ÏÏ°ÏϯϴϬtroduct NameRate teriodÏt RateÏ®t RateFF Rate/ompositeTotal /ostEstimated Annual SaÇingsSET ADN SF $Ϭ/$Ϭ /opaÇ â $ϲϱ Frameϳ/Ï/ϮϬϮÏâϲ/ϯϬ/ϮϬϮÏ$ÏÏ®.ϲϱ$Ϯϯ.ϰϲ$ϰϲ.Ϯϵ$ϯϵ.ÏÏ$ϱϬ,ϮϮϯB/BSM Guardian*MESSA rates include taÇes and fees. *SETSEG SF/ADN rates are illustratiÇe and include a $Ï.ϴϱ per emploÇee per month Çision administration fee.*SETSEG SF/ADN rates are Äased on enrollment and adÇance selfâfunded reserÇe is reÆuired. Declined To QuoteDeclined To QuoteDeclined To Quote Printed On 3/31/2021 Medical Rate SummarÇLakeÇood tuÄlic SchoolsAll EmploÇeesAssumed EffectiÇe Date: ϱ/Ï/ϮϬϮÏ/urrent tlan;sÍ¿ and Segment:ÏtÏ®tFFTotal Annual /ostTeachers MESSA AB/ I/ensusϵϮϮϱϯϲMESSA AB/ tlan Ï $ÏϰϬϬâϬ%; ϯâTier RÇ /ensusÏ®ÏϱÏϳtrioritÇ Health HMO HSA $ÏϰϬϬâϮϬ%; $ÏϬ/$ϰϬ/$ϴϬ RÇ Printed On 3/31/2021