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Provider Information
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Rates
2025 Monthly Premium Rates
| Coverage level | Monthly Premium |
|---|---|
| Employee | $6.09 |
Employee + 1 (Spouse or Child) | $11.56 |
| Family | $16.97 |
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2026 Monthly Premium Rates
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| Note |
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| Enrollment in the Vision plan requires submission of a Cafeteria Form. This form must be submitted each year during Open Enrollment. If the form is not submitted, Vision coverage will end on December 31, 2025. The Cafeteria Form link will become active at the start of Open Enrollment. |
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