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2022-2025 MOU City of Santa Ana & SEIU Full-Time Employees Unit Page 62 <br />The above amounts are inclusive of the CalPERS statutory minimum amount <br />which CalPERS determines and publishes each year. <br />2. Any contribution necessary to maintain benefits under said medical health plans <br />in excess of the amounts set forth above shall be borne entirely by the employee. <br />C. Medical Waiver Option <br />An employee who has primary coverage under another non-City sponsored group <br />medical health plan and voluntarily waives, in writing, their City paid medical <br />health insurance coverage shall receive a cash payment each month in an amount <br />equal to fifty percent (50%) of the total monthly premium amount for the City’s <br />lowest cost single “employee-only” medical health plan. <br />Pursuant to the Affordable Care Act (ACA) Employer Mandate “affordability” <br />determination, an Eligible Opt-Out Arrangement requires the following for <br />employees who opt-out of employer-provided health coverage and receive cash in <br />lieu: <br />1. Employee must provide reasonable evidence that the employee and each <br />member of the employee’s expected tax family (individuals the employee <br />expects to claim personal exemption deduction) have or will have minimum <br />essential coverage (other than coverage in the individual market, whether or not <br />obtained through Covered California) during the period of coverage to which <br />the opt-out arrangement applies; <br />2. The opt-out payment may not be made if the employer knows or has reason to <br />know that the employee or any other member of the employee’s expected tax <br />family does not have or will not have the alternative coverage; <br />3. The evidence of alternative coverage must be provided every plan year to which <br />the eligible opt-out arrangement applies; and <br />4. The reasonable evidence must be provided no earlier than a reasonable period <br />of time before the plan year begins. <br />11.2 Dental Insurance <br />A. The City offers two (2) types of dental insurance plans. One (1) is a Dental Health <br />Maintenance Organization (DHMO) plan and one (1) is a Preferred Provider <br />Organization (PPO) plan. <br />B. The City shall contribute a maximum amount of up to one hundred and ten dollars <br />($110.00) for each employee toward the payment of premiums for dental insurance <br />plans provided by the City for employees and their eligible dependents. Effective <br />the first full pay period following City Council approval of this 2022-2025 MOU,