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APPENDIX C WPA Premium Health Insurance Cost by Coverage Level Janurary 1, 2025 to December 31, 2025 WPA Premium - 60% FTE Health Insurance Cost by Coverage Level Employee Employee Employee Employee Employee January 1, 2025 - December 31, 2025 Only + 1 Child + Children + Spouse + Family Copay E RX7+ VSP + Willamette Dental Copay E RX 7 832.09 $ 1,551.38 $ 2,064.15 $ 1,773.01 $ 2,380.79 $ VSP A (12/12/24) 10.53 $ 12.85 $ 22.91 $ 14.71 $ 26.49 $ Willamette Dental A 58.68 $ 89.65 $ 156.40 $ 102.47 $ 180.40 $ Total Cost 901.30 $ 1,653.88 $ 2,243.46 $ 1,890.19 $ 2,587.68 $ Employee Cost 5% + 40% of employer 387.56 $ 711.17 $ 964.69 $ 812.78 $ 1,112.70 $ Cost to City 513.74 $ 942.71 $ 1,278.77 $ 1,077.41 $ 1,474.98 $ Copay E RX7 + VSP + CIS Dental II (Delta Dental/ODS) Copay E RX 7 832.09 $ 1,551.38 $ 2,064.15 $ 1,773.01 $ 2,380.79 $ VSP A (12/12/24) 10.53 $ 12.85 $ 22.91 $ 14.71 $ 26.49 $ CIS Dental II (Delta Dental) 51.19 $ 77.97 $ 135.72 $ 89.11 $ 156.55 $ Total Cost 893.81 $ 1,642.20 $ 2,222.78 $ 1,876.83 $ 2,563.83 $ Employee Cost 5% + 40% of employer 384.34 $ 706.15 $ 955.80 $ 807.04 $ 1,102.45 $ Cost to City 509.47 $ 936.05 $ 1,266.98 $ 1,069.79 $ 1,461.38 $ Copay E RX7 + VSP + Kaiser Dental Copay E RX 7 832.09 $ 1,551.38 $ 2,064.15 $ 1,773.01 $ 2,380.79 $ VSP A (12/12/24) 10.53 $ 12.85 $ 22.91 $ 14.71 $ 26.49 $ Kaiser Dental II 67.23 $ 103.59 $ 195.25 $ 118.37 $ 225.17 $ Total Cost 909.85 $ 1,667.82 $ 2,282.31 $ 1,906.09 $ 2,632.45 $ Employee Cost 5% + 40% of employer 391.24 $ 717.16 $ 981.39 $ 819.62 $ 1,131.95 $ Cost to City 518.61 $ 950.66 $ 1,300.92 $ 1,086.47 $ 1,500.50 $ Employee Employee Employee Employee Employee Only + 1 Child + Children + Spouse + Family Kaiser Copay B + Kaiser Vision + Willamette Dental Kaiser Copay B 887.55 $ 1,627.65 $ 2,195.31 $ 1,859.43 $ 2,531.06 $ Kaiser Vision 6.76 $ 12.47 $ 16.81 $ 14.26 $ 19.39 $ Willamette Dental A 58.68 $ 89.65 $ 156.40 $ 102.47 $ 180.40 $ Total Cost 952.99 $ 1,729.77 $ 2,368.52 $ 1,976.16 $ 2,730.85 $ Employee Cost 5% +40% of employer 409.79 $ 743.80 $ 1,018.46 $ 849.75 $ 1,174.27 $ Cost to City 543.20 $ 985.97 $ 1,350.06 $ 1,126.41 $ 1,556.58 $ Kaiser Copay B + Kaiser Vision + ODS Delta Dental II Kaiser Copay B 887.55 $ 1,627.65 $ 2,195.31 $ 1,859.43 $ 2,531.06 $ Kaiser Vision 6.76 $ 12.47 $ 16.81 $ 14.26 $ 19.39 $ ODS Delta Dental II 51.19 $ 77.97 $ 135.72 $ 89.11 $ 156.55 $ Total Cost 945.50 $ 1,718.09 $ 2,347.84 $ 1,962.80 $ 2,707.00 $ Employee Cost 5% + 40% of employer 406.57 $ 738.78 $ 1,009.57 $ 844.00 $ 1,164.01 $ Cost to City 538.94 $ 979.31 $ 1,338.27 $ 1,118.80 $ 1,542.99 $ Kaiser Copay B + Kaiser Vision + Kaiser Dental Kaiser Copay B 887.55 $ 1,627.65 $ 2,195.31 $ 1,859.43 $ 2,531.06 $ Kaiser Vision 6.76 $ 12.47 $ 16.81 $ 14.26 $ 19.39 $ Kaiser Dental II 67.23 $ 103.59 $ 195.25 $ 118.37 $ 225.17 $ Total Cost 961.54 $ 1,743.71 $ 2,407.37 $ 1,992.06 $ 2,775.62 $ Employee Cost 5% + 40% of employer 413.46 $ 749.80 $ 1,035.17 $ 856.59 $ 1,193.52 $ Cost to City 548.08 $ 993.91 $ 1,372.20 $ 1,135.47 $ 1,582.10 $