Alder Medical Plan ($400 annual deductible) $0-30 copay/20% coinsurance (in-network)

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1 Alder Medical Plan Airch with Healthy Futures Birch Medical Plan Birch with Healthy Futures $400 annual deductible; $0-20 copay/20% coinsurance (in-network) $300 annual deductible for each Employee and Spouse/Domestic Partner $800 annual deductible; $0-30 copay/20% coinsurance (in-network) $700 annual deductible for each Employee and Spouse/Domestic Partner Cedar Medical Plan $1200 annual deductible; $0-30 copay/20% coinsurance (in-network) Cedar with Healthy Futures $1100 annual deductible for each Employee and Spouse/Domestic Partner Evergreen Medical Plan/HSA* $1600/Individual or $3200/family annual deductible; 20% coinsurance (In-network) *new HSA Plan Health Savings Account (HSA) Evergreen with Healthy Futures $1500/Individual or $3100/Family annual deductible Delta Dental Plan 1 $50 annual deductible; 0-30% coinsurance; $2,200 plan benefit; Ortho $1800max + 20% per visit Willamette Dental No annual deductible; $20 copay; Ortho $1500 copay + $20 per visit EE = Employee Opal Vision Plan Benefit Plan Rates for RETIREES - Contributions are Tiered Rates / COCC Group Health Plan Options No annual deductible; $600 plan benefit; no copays Incentives for reduction to annual deductible during Open Enrollment Only 1. Healthy Futures Program - EE + Spouse/DP complete a Health Assessment by Oct 15 to receive $100 reduction toward annaul deductible Alder Medical Plan ($400 annual deductible) $0-30 copay/20% coinsurance (in-network) Synergy Plan PPO is not available for the Alder Plan Monthly Premium , , , Monthly Premium , , , Monthly Premium , , , Monthly Premium , , , Monthly Premium , , ,000.66

2 Birch Medical Plan ($800 annual deductible) $0-30 copay/20% coinsurance (in-network) Synergy Plan Synergy Plan will not be offered PPO Only Monthly Premium , , , Monthly Premium , , , Monthly Premium , , , Monthly Premium , , , Monthly Premium , , , EE + SPOUSE EE+

3 Cedar Medical Plan ($1200 annual deductible) $0-30 copay/20% coinsurance (in-network) SYNERGY Plan Synergy Plan will not be offered PPO Only Monthly Premium , , , Monthly Premium , , , Monthly Premium , , , Monthly Premium , , , no Dental Monthly Premium , , , EE + SPOUSE EE+

4 Evergreen / HSA Plan ($1600/$3200 annual deductible) No CoPays; 20% coinsurance (in-network) Rates SYNERGY Plan Rates Monthly Premium , , Monthly Premium , , Monthly Premium , , Monthly Premium , Monthly Premium , , Monthly Premium , Monthly Premium , , Monthly Premium , Monthly Premium , Monthly Premium ,255.51

5 STAND ALONE PLAN RATES - Monthly Premium Costs PLAN OPTIONS EE + SPOUSE EE + Alder Medical-Synergy $ $1, $1, $1, EE Cost: $ $1, $1, $1, Birch Medical-PPO $ $1, $1, $1, EE Cost: $ $1, $1, $1, Cedera Medical-PPO $ $1, $1, $1, EE Cost: $ $1, $1, $1, Evergreen Medical - PPO $ $ $ $1, EE Cost: $ $ $ $1, Evergreen Medical - Synergy $ $ $ $1, EE Cost: $ $ $ $1, Delta Dental Plan 1 $63.46 $ $ $ EE Cost: $63.46 $ $ $ Willamette Dental $41.93 $83.03 $88.35 $ EE Cost: $41.93 $83.03 $88.35 $ Opal Vision Plan $21.92 $48.20 $41.62 $67.92 EE Cost: $21.92 $48.20 $41.62 $67.92 Revised clg

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