MONTHLY PAYMENT SUMMARY 2025 Medical & Rx Monthly Rates* Amount You Pay Medical + Amount You Pay Medical + Amount You Pay Medical + Rx Low Plan Option 1 Rx Mid Plan Option 2 Rx High Plan Option 3 $70.99 $134.00 $246.17 * Per Person Covered 2025 Dental and Vision Monthly Rates Vision Plan Dental Plan (Hired after 7/1/05) Retiree $8.08 $30.18 Retiree + Spouse $12.66 $75.00 A check for your first monthly payment is required. Mail a check for your first month’s premium to: DePauw University/Amwins Group Benefits, Inc., 50 Whitecap Drive, North Kingstown, RI 02852 Make your check payable to: DePauw University/Amwins Group Benefits, Inc. If you are interested in monthly automatic withdrawals from your bank account, complete the Direct Payment Authorization form and return it with a voided check and a check for your first month's payment. If you do not sign up for automatic payments, you will begin receiving monthly invoices from Amwins. Please st return a check for your first month's payment in the enclosed return envelope. Payments are due on the 1 of every month.