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Benefits Enrollment for Medical, Vision and Dental effective July 2025.

All MLEDP employees who work a minimum of 25 hours per week are eligible to enroll in one or more of the benefits below. 

After making your selections to accept or waive coverage for each option, please be sure to sign the bottom of the page. 

Employees are responsible for paying 25% of the cost of the single premium through payroll deduction and MLEDP pays 75% of the monthly premium for single coverage and applies that amount to all other coverage levels.

Instructions:

Please read through the benefit options below and select "Accept (Level of coverage you would like)" or "Waive Coverage" for each option. (Medical, Dental and Vision). If you do not wish to be enrolled, please be sure to click "Waive Coverage"

UPMC/ Monthly Payroll Deduction Group Plan

 

Premium

MLEDP

Monthly Cost

(75% of Single Premium)

Individual Employee Monthly Cost

(25% of Premium)

Single: $827.02

$620.27

$206.75

Employee and Spouse

$2213.12

$620.27

$1592.85

P/C $1663.96

$620.27

$1043.69

Family: $2307.40

$620.27

$1687.13

Medical (Select one)

Highmark Fashion Advantage Gold - Opt I/Monthly Payroll Deduction

 

Premium

MLEDP

Monthly Cost (75% of Single Premium)

Individual Employee Monthly Cost

(25% of Premium)

Single: $5.46

$4.10

$1.36

P/C: $15.83

$4.10

$11.73

Family: $15.83

$4.10

$11.73

Vision (Select one)

SunLife/Monthly Payroll Deduction

 

Premium

MLEDP Monthly Cost (75% of Single Premium)

Individual Employee Monthly Cost (25% of Premium)

Single: $23.55

$18.99

$6.33

Emp +1: $45.95

$18.99

$30.41

Family: $78.35

$18.99

$65.24

Dental (Select One)

NOTE: 

  • If you elect Single coverage for medical, dental and vision, your monthly payroll deduction will total $214.44
  • If you elect Emp/Spouse coverage for medical, dental, and vision, your monthly payroll deduction will total: $1634.67
  • If you elect P/C coverage for medical, dental and vision, your monthly payroll deduction will total $1085.83
  • If you elect Family coverage for medical, dental and vision, your monthly payroll deduction will total $1764.10

Benefit Options

AFLAC Benefit Options - To enroll in this program, you will need to work with the AFLAC representative. MLEDP does not pay any portion of the premium.

Sickness, Accident and Short-Term Disability plans are offered through AFLAC.


If you would like more information about AFLAC, contact the MLEDP executive director

All Eligible Employees Please Read and Sign below:

After the enrollment period, you will not be able to make any additional changes during the year unless you experience a qualified life event, such as a birth, death, or spousal job loss.

I have read the information presented on this enrollment form and understand that the costs of the benefit elections I choose will be deducted from my paycheck each month.

Sign above

For Office Use Only:

Sign above

Additional Rate and Schedule Calendar Information

*A Typical School Day is a day when children are scheduled for a regular session of school.

*Typical Days Billing: The Typical Days listed above in the Kindergarten Care Schedule Calendar, are totaled (based on your RSPA agreement) then divided into easy monthly installments.

The following items are billed separately.

  1. **Long Days are in service-clerical days and parent teacher conference days with 11.5 hours of care available.
  2. **Long Days are always billed separately. Since families sign up for care as needed and Long Days are an additional cost, we do not pre-bill for these days. You are only billed for the days for which you sign up. No Tuition Credits are Given for absences on Long Days.
  3. Late Pick Up Fee - $10.00 for every 15-minute increment beyond closing time (6:30 p.m.).
  4. Late Payment Fee - Payments are due the first day of every month. A late fee of 5% of the account balance will be assessed to accounts, if payment arrives after the 5th day of the month.
  5. Failure To Call Off Fee: If your child is scheduled for afternoon care and is absent without calling to inform the center, then you will be charged a $25.00 Failure To Call Off Fee.