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PROPOSAL FORM <br />City of Sunny Isles Beach <br />Bid #00 -11 -01 <br />Group Health Insurance Coverage <br />We propose the following rate structure: <br />Group Health Insurance PPO Program, consistent with the City specifications and <br />details provided by the bidder on attached sheets. <br />Cost per month, per employee: <br />employee employee plus two <br />employee plus one employee plus three or more <br />We propose the following for covered Dental Expense: <br />Calendar year deductible per participant <br />Calendar year maximum per participant <br />Preventive <br />Basic <br />Restoration & Specialty <br />Orthodontia <br />We propose the following for Vision Care: <br />Exam Lenses <br />Frames Contacts <br />We propose the following for Prescription Drugs: <br />In Network, Generic Brand Name <br />Out of Network <br />The City reserves the right to reject any and all bids. <br />