3.1 FY 2020-21 VISION PLAN EXHIBIT A PREMIUM RATES.DOCX

Employee Benefits – Plan Year 2021 Premium Rates – Exhibit A
FY 2020-2021 Vision
Full-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 6.80 5.48 1.32
EyeMed Employee + Spouse 13.02 10.12 2.90
Employee + Child(ren) 13.18 11.00 2.18
Employee + Family 19.82 15.92 3.90
Part-time Active Employees
Monthly Monthly
Monthly Total Employer Employee
Plan Tier Premium Premium Premium
Employee 6.80 2.74 4.06
EyeMed Employee + Spouse 13.02 5.06 7.96
Employee + Child(ren) 13.18 5.50 7.68
Employee + Family 19.82 7.96 11.86