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Dental & Vision
Premium Cost Sharing
Dental
PPO
Dental Plan
UHC Dental
Monthly Per Paycheck
Enrollment Tier
Employee Cost Employee Cost
Employee only $36.55 $0.00
Employee + Spouse $73.09 $36.54
Employee + Child(ren) $80.32 $43.77
Employee + Family $122.71 $86.16
Vision
PPO
Vision Plan
Humana
Monthly Per Paycheck
Enrollment Tier
Employee Cost Employee Cost
Employee only $5.33 $0.00
Employee + Spouse $10.67 $5.34
Employee + Child(ren) $10.13 $4.80
Employee + Family $15.92 $10.59
*Rate is valid effective 8/1/2021-7/31/2022
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