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cost of single employee health insurance per month for each full month; payment will be <br />made on a bi- weekly basis and will be subject to ordinary income taxes. <br />With this choice, an employee would opt -out for themselves and /or their eligible <br />dependents. This option applies to medical coverage only. For employees with <br />dependent coverage, opt -out is for employee and family coverage or family coverage, <br />retaining the employee's individual coverage - there is no other choice. Medical benefits <br />through the City of Little Canada will be available to Opt -Out participants should they <br />lose their coverage provided by another source subject to the City's insurance carrier's <br />regulations. Open enrollment in the City's Insurance Program is available only as <br />designated by the City's insurance carrier. <br />Examples of Opt Out Calculation: <br />OPT OUT OF SINGLE COVERAGE OPT GU- <br />;r e • <br />Single Cevemge- Amrreunt City-Cap-Amount <br />X 50% X SO% <br />Opt Out Payment to Employee Opt Out- Payment- te- Empleyee <br />OPT -OUT OF FAMILY COVERAGE—LESSER 0E-T-FIE TWO <br />City Cap Amount <br />Cost-of Single Cevcrage <br />X50% <br />went e- Empleyee <br />Cost of Single Coverage <br />X50% <br />leyee <br />Y--COv <br />Participants in the Opt -Out Program must sign a release and show proof of medical benefits <br />through another source. The City will have the right to refuse the Opt -Out option for an <br />employee should the City's participation in its Health Insurance Program be jeopardized. <br />Employees choosing to discontinue the Opt -Out program and enroll in the City's Health <br />Insurance Program must do so during enrollment periods as authorized by the City's health <br />Insurance Carrier. Enrollment may be subject to pre - qualification. <br />