3.1 PY 2025 VISION PLAN PREMIUM RATES_EXHIBIT A.PDF

Vision Benefits – Premium Rates – Exhibit A 
Plan Year 1/1/2025 to 12/31/2025  
Monthly Premium Rates 
 
Full-time Active Employees 
 Plan  
 Tier  
Total Premium  
Employer 
Premium  
 Employee 
Premium  
               Employee 
           6.80  
         5.48  
            1.32  
Vision 
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  
Total Premium  
Employer 
Premium  
 Employee 
Premium  
               Employee 
          6.80  
         2.74  
            4.06  
Vision 
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