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Self-Pay Insurance
for Faculty, Staff & Librarians — Self-Pay Rates

These rates are for employees in a leave-without-pay (LWOP) or reduction-in-force (RIF) situation. Medicare rates are not available to these subscribers.

2013 Rates: Effective January 1, 2013

Medical rates

 Uniform Medical Plan Classic Uniform Medical Plan CDHP w/HSA Group Health Classic Group Health Value Group Health CDHP w/HSA Kaiser Permanente Classic Kaiser Permanente CDHP w/HSA
Subscriber Only
$545.83
$499.95
$584.66
$535.22
$513.77
$567.06
$498.95
Subscriber & Spouse/QDP
1,085.48
990.26
1,163.14
1,064.26
1,018.40
1,127.94
988.26
Subscriber & Child(ren)
950.57
882.27
1,018.52
932.00
906.83
987.72
880.52
Full Family
1,490.22
1,314.25
1,597.00
1,461.04
1,353.13
1,548.60
1,311.50

Dental rates (with medical)

  Uniform Dental Plan, administered by WDS DeltaCare,
administered by WDS		 Willamette Dental
Subscriber Only
$46.34
$39.53
$40.20
Subscriber & Spouse/QDP
92.68
79.06
80.40
Subscriber & Child(ren)
92.68
79.06
80.40
Full Family
139.02
118.59
120.60

Dental rates (without medical)**

  Uniform Dental Plan, administered by WDS DeltaCare,
administered by WDS		 Willamette Dental
Subscriber Only
$52.52
$45.71
$46.38
Subscriber & Spouse/QDP
98.86
85.24
86.58
Subscriber & Child(ren)
98.86
85.24
86.58
Full Family
145.20
124.77
126.78

*QDP = Qualified Domestic Partner

** Rates are subject to change.

Leave/Layoff
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