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 1 2016-17 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 708.83 1,545.51 1,366.01 2,207.68 Monthly Premium 687.30 1,502.83 1,314.56 2,133.43 Monthly Premium 686.91 1,497.31 1,324.39 2,139.76 Monthly Premium 665.38 1,454.63 1,272.94 2,065.51 Monthly Premium 645.37 1,419.80 1,226.21 2,000.66
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 698.41 1,522.55 1,346.17 2,175.33 Monthly Premium 676.88 1,479.87 1,294.72 2,101.08 Monthly Premium 676.49 1,474.35 1,304.55 2,107.41 Monthly Premium 654.96 1,431.67 1,253.10 2,033.16 Monthly Premium 634.95 1,396.84 1,206.37 1,968.31 EE + SPOUSE EE+
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 637.89 1,389.42 1,231.19 1,987.75 Monthly Premium 616.36 1,346.74 1,179.74 1,913.50 Monthly Premium 615.97 1,341.22 1,189.57 1,919.83 Monthly Premium 594.44 1,298.54 1,138.12 1,845.58 no Dental Monthly Premium 552.51 1,215.51 1,049.77 1,712.81 EE + SPOUSE EE+
Evergreen / HSA Plan ($1600/$3200 annual deductible) No CoPays; 20% coinsurance (in-network) Rates SYNERGY Plan Rates Monthly Premium 511.03 1,110.34 990.17 1,594.47 Monthly Premium 468.47 1,016.71 909.30 1,462.53 Monthly Premium 489.50 1,067.66 938.72 1,520.22 Monthly Premium 446.94 974.03 857.85 1,388.28 Monthly Premium 489.11 1,062.14 948.55 1,526.55 Monthly Premium 446.55 968.51 867.68 1,394.61 Monthly Premium 467.58 1,019.46 897.10 1,452.30 Monthly Premium 425.02 925.83 816.23 1,320.36 Monthly Premium 447.57 984.63 850.37 1,387.45 Monthly Premium 405.01 891.00 769.50 1,255.51
STAND ALONE PLAN RATES - Monthly Premium Costs PLAN OPTIONS EE + SPOUSE EE + Alder Medical-Synergy $623.45 $1,371.60 $1,184.59 $1,932.74 EE Cost: $623.45 $1,371.60 $1,184.59 $1,932.74 Birch Medical-PPO $613.03 $1,348.64 $1,164.75 $1,900.39 EE Cost: $613.03 $1,348.64 $1,164.75 $1,900.39 Cedera Medical-PPO $552.51 $1,215.51 $1,049.77 $1,712.81 EE Cost: $552.51 $1,215.51 $1,049.77 $1,712.81 Evergreen Medical - PPO $425.65 $936.43 $808.75 $1,319.53 EE Cost: $425.65 $936.43 $808.75 $1,319.53 Evergreen Medical - Synergy $383.09 $842.80 $727.88 $1,187.59 EE Cost: $383.09 $842.80 $727.88 $1,187.59 Delta Dental Plan 1 $63.46 $125.71 $139.80 $207.02 EE Cost: $63.46 $125.71 $139.80 $207.02 Willamette Dental $41.93 $83.03 $88.35 $132.77 EE Cost: $41.93 $83.03 $88.35 $132.77 Opal Vision Plan $21.92 $48.20 $41.62 $67.92 EE Cost: $21.92 $48.20 $41.62 $67.92 Revised 8.18.16 clg