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<br />DEC-08-Z000 13:51 <br /> <br />FROM-BROWN AND BROWN INC <br /> <br />30536Z344Z <br /> <br />T-OZ3 P.OOZ/003 F-689 <br /> <br />Aetna US Access <br /> <br />PLAN 5 <br /> <br />PROPOSAL FORM <br />City of Sunny Isles Beach <br />Bid #00-11-01 <br />Group Health Insurance Coverage <br /> <br />We propose the folJowing f3r~ structure: <br />Group Health Insurance PPO Program, consistent with the City specifications and <br />details provided by the bidder on attached sheets. <br /> <br />Cost per month, per employee: <br /> <br />627.70 <br /> <br />employee + spouse <br />employee + family <br /> <br />i_214. ~ employee $, <br />$, 401.60 employee + child/renl $ <br /> <br />477 . 40 <br /> <br />\~'e propose the following for covered Dental Expense: <br /> <br />C:llencl::tr year deductibl~ <br /> <br />per participant <br /> <br />Calendar year maximum <br /> <br />per participant <br /> <br />Preventive <br /> <br />B~sic <br /> <br />Rescomticn &; Spec~alty <br /> <br />Orthodonti:l. <br /> <br />W'e propose the following for Vision Care: <br /> <br />~revp.111a.tlve vl~lon lncluded in premium. <br /> <br />Exam $10- Routine <br /> <br />Lenses Di scoul'ltE!d <br /> <br />Fr;1mes ni ~C'nl)n1-_pri <br /> <br />Contacts ni <:;t""nnntpd <br /> <br />W.'e propose the following for Prescription Drugs: <br /> <br />In Ne~"'orkl G~neric $10 <br /> <br />Brand Name <br /> <br />$15 <br /> <br />Non-Formulary J 30 <br /> <br />Out oCNet'work_80% after d.eductible <br /> <br />The City resen.-es the right to reject an)- and all bids. <br /> <br />-:~1'~1: .."..~...,;~ ''':::,"~~,,~ 1.H")r).: .;.'" ";::-::...~~~ '!=1~.':~~' ::.,.~~.....,y ,-~.'-~6~wrltlns. <br />