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~rsthem~ <br />Mayfield Village <br />ooo34sss <br />04101122007 <br />CUR(I2ENT BENEFITS <br />Blue Acc®ss v02 Option 1 $8/95/25 rx <br />Dental None <br />Vision None <br /> CURRENT RATES <br />Coverage Contracts <br />- <br />_....._.. <br />-•--- <br />EE 8 $ 387.33 <br />EEISP 11 $ 925.54 <br />EE/CH 4 $ 711.01 <br />FAMILY 32 $ 1,300.30 <br />YOTAL 55 $ 57,733.22 <br />Total Monthly Premium' $ 57;.733..22 <br />RENEWAL BENEFITS <br />Access v02 Option 1 $8/15/25 rx <br /> RENEWAL RATES <br />;overage _ Contracts <br />EE 8 $ 429.94 <br />EEISP 11 $ 1, 027.35 <br />EI=/CH 4 $ 789.22 <br />FAMILY 32 $ 1,443.33 <br />TOTAL 55 ~ fi4,083.81 <br />Total Monthly Premium' $ 64,083..81 <br />Renewal Increase: 11.00% <br />EXHIBIT A <br />