3.1 FY 2022-23 VISION PLAN PREMIUM RATES_EXHIBIT A.PDF

Maricopa County — Formal (2021-12-08)

View PDF Item 61 Meeting page

Extracted text (via pymupdf) 985 characters 
Vision Benefits – Premium Rates – Exhibit A 
FY 2022-2023  
Based on 26 Pay Periods 
 
Full-time Active Employees 
 Plan  
 Tier  
 Pay Period 
Total Premium  
Pay Period 
Employer 
Premium  
 Pay Period 
Employee 
Premium  
               Employee 
           3.14  
         2.52  
            0.62  
EyeMed 
Employee + Spouse 
           6.01  
         4.68  
            1.33  
  
Employee + Child(ren) 
           6.08  
         5.06  
            1.02  
  
Employee + Family 
           9.15  
         7.34  
            1.81  
 
Part-time Active Employees   
 Plan  
 Tier  
 Pay Period 
Total Premium 
Pay Period 
Employer 
Premium 
 Pay Period 
Employee 
Premium 
               Employee 
           3.14  
         1.26  
            1.88  
EyeMed 
Employee + Spouse 
           6.01  
         2.34  
            3.67  
  
Employee + Child(ren) 
           6.08  
         2.53  
            3.55  
  
Employee + Family 
           9.15  
         3.67  
            5.48