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APPENDIX C WPA Premium Health Insurance Cost by Coverage Level Janurary 1, 2026 to December 31, 2026 WPA Premium - 75% FTE Health Insurance Cost by Coverage Level Employee Employee Employee Employee Employee January 1, 2026 - December 31, 2026 Only + 1 Child + Children + Spouse + Family Copay E RX7+ VSP + Willamette Dental Copay E RX 7 906.74 $ 1,690.42 $ 2,249.31 $ 1,932.03 $ 2,594.34 $ VSP A (12/12/24) 11.17 $ 13.61 $ 24.29 $ 15.59 $ 28.07 $ Willamette Dental A 62.78 $ 95.92 $ 167.33 $ 109.64 $ 193.01 $ Total Cost 980.69 $ 1,799.95 $ 2,440.93 $ 2,057.26 $ 2,815.42 $ Employee Cost 5% + 25% of employer 281.95 $ 517.49 $ 701.77 $ 591.46 $ 809.43 $ Cost to City 698.74 $ 1,282.46 $ 1,739.16 $ 1,465.80 $ 2,005.99 $ Copay E RX7 + VSP + CIS Dental II (Delta Dental/ODS) Copay E RX 7 906.74 $ 1,690.42 $ 2,249.31 $ 1,932.03 $ 2,594.34 $ VSP A (12/12/24) 11.17 $ 13.61 $ 24.29 $ 15.59 $ 28.07 $ CIS Dental II (Delta Dental) 53.78 $ 81.93 $ 142.61 $ 93.64 $ 164.49 $ Total Cost 971.69 $ 1,785.96 $ 2,416.21 $ 2,041.26 $ 2,786.90 $ Employee Cost 5% + 25% of employer 279.36 $ 513.46 $ 694.66 $ 586.86 $ 801.23 $ Cost to City 692.33 $ 1,272.50 $ 1,721.55 $ 1,454.40 $ 1,985.67 $ Copay E RX7 + VSP + Kaiser Dental Copay E RX 7 906.74 $ 1,690.42 $ 2,249.31 $ 1,932.03 $ 2,594.34 $ VSP A (12/12/24) 11.17 $ 13.61 $ 24.29 $ 15.59 $ 28.07 $ Kaiser Dental II 69.25 $ 106.70 $ 200.91 $ 121.93 $ 231.69 $ Total Cost 987.16 $ 1,810.73 $ 2,474.51 $ 2,069.55 $ 2,854.10 $ Employee Cost 5% + 25% of employer 283.81 $ 520.58 $ 711.42 $ 595.00 $ 820.55 $ Cost to City 703.35 $ 1,290.15 $ 1,763.09 $ 1,474.55 $ 2,033.55 $ Employee Employee Employee Employee Employee Only + 1 Child + Children + Spouse + Family Kaiser Copay B + Kaiser Vision + Willamette Dental Kaiser Copay B 1,002.60 $ 1,838.96 $ 2,480.39 $ 2,100.89 $ 2,859.80 $ Kaiser Vision 7.18 $ 13.25 $ 17.85 $ 15.14 $ 20.58 $ Willamette Dental A 62.78 $ 95.92 $ 167.33 $ 109.64 $ 193.01 $ Total Cost 1,072.56 $ 1,948.13 $ 2,665.57 $ 2,225.67 $ 3,073.39 $ Employee Cost 5% + 25% of employer 308.36 $ 560.09 $ 766.35 $ 639.88 $ 883.60 $ Cost to City 764.20 $ 1,388.04 $ 1,899.22 $ 1,585.79 $ 2,189.79 $ Kaiser Copay B + Kaiser Vision + ODS Delta Dental II Kaiser Copay B 1,002.60 $ 1,838.96 $ 2,480.39 $ 2,100.89 $ 2,859.80 $ Kaiser Vision 7.18 $ 13.25 $ 17.85 $ 15.14 $ 20.58 $ ODS Delta Dental II 53.78 $ 81.93 $ 142.61 $ 93.64 $ 164.49 $ Total Cost 1,063.56 $ 1,934.14 $ 2,640.85 $ 2,209.67 $ 3,044.87 $ Employee Cost 5% + 25% of employer 305.77 $ 556.07 $ 759.24 $ 635.28 $ 875.40 $ Cost to City 757.79 $ 1,378.07 $ 1,881.61 $ 1,574.39 $ 2,169.47 $ Kaiser Copay B + Kaiser Vision + Kaiser Dental Kaiser Copay B 1,002.60 $ 1,838.96 $ 2,480.39 $ 2,100.89 $ 2,859.80 $ Kaiser Vision 7.18 $ 13.25 $ 17.85 $ 15.14 $ 20.58 $ Kaiser Dental II 69.25 $ 106.70 $ 200.91 $ 121.93 $ 231.69 $ Total Cost 1,079.03 $ 1,958.91 $ 2,699.15 $ 2,237.96 $ 3,112.07 $ Employee Cost 5% + 25% of employer 310.22 $ 563.19 $ 776.01 $ 643.41 $ 894.72 $ Cost to City 768.81 $ 1,395.72 $ 1,923.14 $ 1,594.55 $ 2,217.35 $ Employee Employee Employee Employee Employee Only + 1 Child + Children + Spouse + Family Surest + VSP + Willamette Dental Surest 803.93 $ 1,496.22 $ 1,989.98 $ 1,709.70 $ 2,294.81 $ VSP A (12/12/24) 11.17 $ 13.61 $ 24.29 $ 15.59 $ 28.07 $ Willamette Dental A 62.78 $ 95.92 $ 167.33 $ 109.64 $ 193.01 $ Total Cost 877.88 $ 1,605.75 $ 2,181.60 $ 1,834.93 $ 2,515.89 $ Employee Cost 5% + 25% of employer 252.39 $ 461.65 $ 627.21 $ 527.54 $ 723.32 $ Cost to City 625.49 $ 1,144.10 $ 1,554.39 $ 1,307.39 $ 1,792.57 $ Surest + VSP + ODS Delta Dental II Surest 803.93 $ 1,496.22 $ 1,989.98 $ 1,709.70 $ 2,294.81 $ VSP A (12/12/24) 11.17 $ 13.61 $ 24.29 $ 15.59 $ 28.07 $ ODS Delta Dental II 53.78 $ 81.93 $ 142.61 $ 93.64 $ 164.49 $ Total Cost 868.88 $ 1,591.76 $ 2,156.88 $ 1,818.93 $ 2,487.37 $ Employee Cost 5% + 25% of employer 249.80 $ 457.63 $ 620.10 $ 522.94 $ 715.12 $ Cost to City 619.08 $ 1,134.13 $ 1,536.78 $ 1,295.99 $ 1,772.25 $ Surest + VSP + Kaiser Dental Surest 803.93 $ 1,496.22 $ 1,989.98 $ 1,709.70 $ 2,294.81 $ VSP A (12/12/24) 11.17 $ 13.61 $ 24.29 $ 15.59 $ 28.07 $ Kaiser Dental II 69.25 $ 106.70 $ 200.91 $ 121.93 $ 231.69 $ Total Cost 884.35 $ 1,616.53 $ 2,215.18 $ 1,847.22 $ 2,554.57 $ Employee Cost 5% + 25% of employer 254.25 $ 464.75 $ 636.86 $ 531.08 $ 734.44 $ Cost to City 630.10 $ 1,151.78 $ 1,578.32 $ 1,316.14 $ 1,820.13 $