Page History
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| Coverage level | Cost |
|---|---|
| Employee | $6.09 |
| Employee + One | $11.56 |
| Family | $16.97 |
Form to complete for 2017
Enrollment form
2016 Monthly Premium Rates
| Coverage level | Cost |
|---|---|
| Employee | $5.91 |
| Employee + One | $11.22 |
| Family | $16.48 |
Forms to complete for 2016
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| Note |
|---|
| Vision enrollment requires submission of the Reliant Cafeteria Plan Enrollment Form. The cafe form must be submitted each year. Otherwise, the vision benefit will end. |
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