3.1 FY 2021-22 VISION PLAN EXHIBIT A PREMIUM RATES.DOCX

Maricopa County — Formal (2020-11-18)

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Employee Benefits – Plan Year 2022 Premium Rates – Exhibit A
FY 2021-2022 Vision
Full-time Active Employees
 Plan 
 Tier 
 Monthly Total 
Premium 
 Monthly 
Employer 
Premium 
 Monthly 
Employee 
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  
 Plan 
 Tier 
 Monthly Total 
Premium 
 Monthly 
Employer 
Premium 
 Monthly 
Employee 
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