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2018 Classified Retiree Rates 50.70% District Contribution Effective October 1, 2018 - September 30, 2019 All rates incl...

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2018 Classified Retiree Rates 50.70% District Contribution Effective October 1, 2018 - September 30, 2019 All rates include medical, prescription, vision and the indicated dental plan

Delta Dental Plan 5 Includes Medical, Rx, Vision, & Delta Dental Plan 5 Retiree Only Retiree + Spouse/◊Domestic Partner Retiree + Children Retiree + Family

Delta Dental Plan 6 Includes Medical, Rx, Vision, & Delta Dental Plan 6 Retiree Only Retiree + Spouse/◊Domestic Partner Retiree + Children Retiree + Family

Willamette Dental Includes Medical, Rx, Vision, & Willamette Dental Retiree Only Retiree + Spouse/◊Domestic Partner Retiree + Children Retiree + Family

*Waive Dental Includes Medical, Rx & Vision Retiree Only Retiree + Spouse/◊Domestic Partner Retiree + Children Retiree + Family

Kaiser Permanente

Moda - Connexus PPO

Kaiser Permanente HMO Plan 2

Connexus PPO Cedar

Connexus PPO Dogwood

$800 deductible $397.28 $1,104.07 $954.04 $1,665.49

$1,200 deductible $488.87 $1,280.83 $1,110.11 $1,906.67

$1,600 deductible $446.14 $1,186.85 $1,028.96 $1,774.25

Kaiser Permanente

Moda - Connexus PPO

Kaiser Permanente HMO Plan 2

Connexus PPO Cedar

Connexus PPO Dogwood

$800 deductible $382.59 $1,074.92 $913.24 $1,609.17

$1,200 deductible $474.18 $1,251.68 $1,069.31 $1,850.35

$1,600 deductible $431.45 $1,157.70 $988.16 $1,717.93

Kaiser Permanente

Moda - Connexus PPO

Kaiser Permanente HMO Plan 2

Connexus PPO Cedar

Connexus PPO Dogwood

$800 deductible $384.49 $1,078.75 $921.54 $1,619.43

$1,200 deductible $476.08 $1,255.51 $1,077.61 $1,860.61

$1,600 deductible $433.35 $1,161.53 $996.46 $1,728.19

Kaiser Permanente

Moda - Connexus PPO

Kaiser Permanente HMO Plan 2

Connexus PPO Cedar

Connexus PPO Dogwood

$800 deductible $338.96 $988.54 $825.56 $1,475.23

$1,200 deductible $430.55 $1,165.30 $981.63 $1,716.41

$1,600 deductible $387.82 $1,071.32 $900.48 $1,583.99

Moda - Synergy CCM Synergy CCM Cedar Synergy CCM Dogwood $1,200 deductible $429.51 $1,150.28 $997.36 $1,722.72

$1,600 deductible $391.06 $1,065.66 $924.29 $1,603.46

Moda - Synergy CCM Synergy CCM Cedar Synergy CCM Dogwood $1,200 deductible $414.82 $1,121.13 $956.56 $1,666.40

$1,600 deductible $376.37 $1,036.51 $883.49 $1,547.14

Moda - Synergy CCM Synergy CCM Cedar Synergy CCM Dogwood $1,200 deductible $416.72 $1,124.96 $964.86 $1,676.66

$1,600 deductible $378.27 $1,040.34 $891.79 $1,557.40

Moda - Synergy CCM Synergy CCM Cedar Synergy CCM Dogwood $1,200 deductible $371.19 $1,034.75 $868.88 $1,532.46

$1,600 deductible $332.74 $950.13 $795.81 $1,413.20

◊Members who enroll a domestic partner and/or child(ren) of a domestic partner in insurance are subject to an imputed income tax on their monthly paycheck. Ensure you understand the tax implecations before enrolling a domestic partner, or a child(ren) of a domestic partner prior to enrollment. Additional information can be found on the 4J Benefits website or by calling 4J Benefits at 541-790-7670. *Retirees who waive dental insurance are not eligible to enroll in a dental plan in the future.