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In consideration of the payment of Premiums when due and subject to all of the terms of this Agreement, <br />Blue Cross Blue Shield of Florida, Inc. hereby agrees to provide each enrollee of Indian River Board of <br />County Commissioners the benefits of this Agreement as set forth in the Evidence of Coverage <br />beginning on each enrollee's effective date. <br />The Group has selected the following plan and premium: Advance Plan PPOwith DHV <br />Breakdown Info for GSS: <br />Advanced Platinum PPO with DHV-current plan. <br />Medical: $6.10 <br />Rx: $250.18 <br />D/V/H : $10.00 <br />Fitness: $4.00 <br />TOTAL: $270.28 pmpm <br />The Group's Agreement is effective as of October 1, 2022. <br />IN WITNESS WHEREOF, the parties have executed this Agreement as of <br />Blue Cross Blue Shield of Florida, Inc. Indian River Board of Coun ommissioners <br />(DBA Florida Blue) <br />By:Izz"ZIze- By: <br />(Sig a re) <br />Name: Rick Kohn <br />(Please Print or Type) <br />Name: Jason E. Brown <br />(Please Print or Type) <br />Title: Vice President, Government Programs Title: <br />IF <br />County Administrator <br />