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June 1, 2015 <br />Dick Cook <br />014 Hibiscus Way <br />Placentia, CA 92870 <br />Re: City of Santa Ana #142337 <br />Renewal — 111118 <br />Dear Dick Cook, <br />Mett.ife appreciates the opportunity to be a part of your benefit program. This letter confirms <br />your renewal for the 2016 plan year. <br />In determining the rates for the coming plan year, we have evaluated your plan experience, <br />taking into account the credibility of the experience and the demographics of your group. Our <br />objective in the renewal process is to identify rates that will maintain the overall financial stability <br />of your benefit program. <br />We have set the following rates for the coming year: <br />Coverage <br />Current <br />Ranewai <br />e in <br />• Em to ee onl <br />Rate Fee <br />RatelPee <br />ee <br />=R <br />• Em to ee + Pamil <br />$45.98 <br />DHMO <br />• Em to ee onl <br />$26.89 <br />$26.88 <br />+6.0 °f° <br />• Em to ee + Pamil <br />$45.98 <br />The Patient Pmtecl` on and Affordable Care Act ( `PPACA") indude!s a health ;rlsttaance industry flee 9enpaseci aos ad <br />health insuram, including dental and vlsican insarers. As with the, prior year, tills Pea is included in ttae dantai <br />and /m Vision ragas above. <br />The rates shown above assume your existing plan design, contribution structure and group <br />demographics remain the same. <br />Please do not hesitate to contact me at 949 -471 -2310 if I may answer any questions or assist in <br />any way. <br />Once again, thank you for the privilege you have extended to us, You are the reason we are in <br />business, We look forward to continuing our relationship in the months and years ahead. <br />Sincerely, <br />Nick Sala <br />Account Executive <br />Pecluest to Notify Alaska f+e5idertts of Impending Covtrage and /or Premium Chaanooe <br />Uod r Ala ka Sfat- to 2 L36 225 covered hrJN 1uais r' ,.piny u 1 asr<a nlu t nP ,oGred e),' inn endieg <ovP rya 3r;QWr prenvun� <br />-rstnosos, as aGpkcnble If you - 6ve I a ti in Ala ca a y c i r e tmler MM ` D sa d l.r Drr t'nl, fi , n ai <br />Aui dF t tai Dmth 3( (. I)iy . P!!TY.k t ; ;lGlit;° , e das 'hdC a wv -de r nn,r n•rf I r it .", t> ,aavf rn ae1 nrL . ^vP (b:' <br />2riPt.ive .. ate 0,`I %t . nG+ndf, R,offvL q t=;tem C `l .h..r'r"ie if ;r ai' (M!U t I ➢7Y -har%t Una: refi,Lo t .i+..alP- HIE II R� d'i, B <br />^21_i;rld nonce nlla,t .P provided _t ne TIM he.' ",mot.:, cP ,r < ..JVc ..,1_ .,r r d,— chanyr -i ✓m vv ,Pd ,r, , r i r. n5nr <br />Ct 1';r '111"1 'Our "9e r e t ✓Ico' r'a(it. <br />25E -11 <br />