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• <br />• <br />Option 9 <br />EyeMed Vision <br />PROPOSAL FORM <br />City of Sunny Isles Beach <br />Bid #00 -11 -01 <br />Group Vision' 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 />$5.07 employee <br />$9.64 employee + child <br />$9.64 employee + spouse <br />$14.19 employee + family <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 Caieo <br />Exam $10 Lenses See Attached <br />Frames See Attached Contacts ,;Ptn A_ .a h d <br />We propose the following for Prescription Drugs: <br />In Network, Generic Brand Name <br />Out of Network <br />Non - Formulary <br />The City reserves the right to reject any and all bids. <br />Final rates based upon enrollment census ¢ carrier underwriting. <br />