Employee Benefit Trust

Vision Service Plan rates

	2024 rate	2025 rate	% Increase from 2024
No copay
Employee	10.96	10.96	0
Employee + 1	21.92	21.92	0
Employee + 2	32.88	32.88	0
$10 copay
Employee	9.54	9.54	0
Employee + 1	19.06	19.06	0
Employee + 2	28.58	28.58	0
$25 copay
Employee	7.72	7.72	0
Employee + 1	15.44	15.44	0
Employee + 2	23.16	23.16	0
$10/$15 copay
Employee	6.10	6.10	0
Employee + 1	12.20	12.20	0
Employee + 2	18.30	18.30	0
No copay with second pair option rider
Employee	12.02	12.02	0
Employee + 1	24.04	24.04	0
Employee + 2	36.06	36.06	0
$10 copay with second pair option rider
Employee	10.58	10.58	0
Employee + 1	21.18	21.18	0
Employee + 2	31.76	31.76	0
$25 copay with second pair option rider
Employee	8.78	8.78	0
Employee + 1	17.56	17.56	0
Employee + 2	26.34	26.34	0