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APPENDIX C WPA Premium Health Insurance Cost by Coverage Level Janurary 1, 2026 to December 31, 2026 WPA Premium - 60% 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% + 40% of employer 421.70 $ 773.98 $ 1,049.60 $ 884.62 $ 1,210.63 $ Cost to City 558.99 $ 1,025.97 $ 1,391.33 $ 1,172.64 $ 1,604.79 $ 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% + 40% of employer 417.83 $ 767.96 $ 1,038.97 $ 877.74 $ 1,198.37 $ Cost to City 553.86 $ 1,018.00 $ 1,377.24 $ 1,163.52 $ 1,588.53 $ 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% + 40% of employer 424.48 $ 778.61 $ 1,064.04 $ 889.91 $ 1,227.26 $ Cost to City 562.68 $ 1,032.12 $ 1,410.47 $ 1,179.64 $ 1,626.84 $ 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% + 40% of employer 461.20 $ 837.70 $ 1,146.20 $ 957.04 $ 1,321.56 $ Cost to City 611.36 $ 1,110.43 $ 1,519.37 $ 1,268.63 $ 1,751.83 $ 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% + 40% of employer 457.33 $ 831.68 $ 1,135.57 $ 950.16 $ 1,309.29 $ Cost to City 606.23 $ 1,102.46 $ 1,505.28 $ 1,259.51 $ 1,735.58 $ 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% + 40% of employer 463.98 $ 842.33 $ 1,160.63 $ 962.32 $ 1,338.19 $ Cost to City 615.05 $ 1,116.58 $ 1,538.52 $ 1,275.64 $ 1,773.88 $ Employee Employee Employee Employee Employee Only + 1 Child + Children + Spouse + Family Surest + VSP A + 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% + 40% of employer 377.49 $ 690.47 $ 938.09 $ 789.02 $ 1,081.83 $ Cost to City 500.39 $ 915.28 $ 1,243.51 $ 1,045.91 $ 1,434.06 $ Surest + VSP A + 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% + 40% of employer 373.62 $ 684.46 $ 927.46 $ 782.14 $ 1,069.57 $ Cost to City 495.26 $ 907.30 $ 1,229.42 $ 1,036.79 $ 1,417.80 $ Surest + VSP A + 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% + 40% of employer 380.27 $ 695.11 $ 952.53 $ 794.30 $ 1,098.47 $ Cost to City 504.08 $ 921.42 $ 1,262.65 $ 1,052.92 $ 1,456.10 $